Questions Flashcards
1
Q
Choice of drug for long term prevention of stroke in a fib patients?
A
Warfarin
2
Q
RBC does not have what enzyme?
A
Alpha ketogluratate dehydrogenase
3
Q
Valsalva maneuver and corresponding change in preload, afterload and SV?
A
As intrathoracic pressure increases, preload decreases and afterload increases, which causes stroke volume to decrease
4
Q
Difference between dystrophic calcification and metastatic calcification?
A
Dystrophic calcification - inflamed or degenerative site undergoing localized calcification following injury or necrosis
Metastatic calcification - normal site undergoing diffused calcification following systemic hypercalcemia
5
Q
Surface markers of B cells and T cells?
A
B cell - CD19, CD20, CD21, CD40
T cell - CD8, CD4, CD40L, CD25, CD28
6
Q
Favorable prognostic factor for ALL
A
t(12:21)
7
Q
Favourable prognostic factor for AML
A
t(8:21) - AML
t(15:17) - APML
8
Q
Most common complication of Kawasaki disease?
A
Coronary artery aneurysm
9
Q
What enzyme involved in TG synthesis is not present in adipose tissue but present in liver?
A
Glycerol kinase
10
Q
Undercooked meat consumption; presents with fever, right leg pain and swelling, periorbital edema, conjunctival haemorrhage?
A
Trichinellosis (helminth infection), lives in the muscle
11
Q
Consumption of dapsone, and now presenting with cyanosis and chocolate colored blood, Dx?
A
Methemoglobinemia
12
Q
Ergot alkaloid therapy and upper urinary tract obstruction predisposes you to?
A
Retroperitoneal fibrosis
13
Q
Left hemithorax at 4th IC space at midclavicular line puncture will affect what structure?
A
Upper lobe of left lung
14
Q
Small child, bloody diarrhoea, microcytic anemia
A
Meckel’s diverticulum - ectopic gastric mucosa and/or pancreatic tissue on technetium 99m pertechnetate scan
15
Q
Most common meningitis virus in children?
A
Echovirus
16
Q
Pathophysiology of Chagas disease?
A
Caused by trypanosoma
Sx: inflammatory edema, painless edema of eyelids; cardiomyopathy, achalasia, megacolon
Confirm with giemsa dye
Treat with benznidazole
17
Q
BUN/Cr ratio for pre-renal, intrarenal and post-renal
A
10:1 - 20:1: normal, postrenal cause
>=20:1 - prerenal cause
<=15:1 - intrarenal cause
18
Q
AKI FeNa for pre-renal and intrarenal?
A
Low FeNa (<1%) - pre-renal cause
High FeNa (>2%) - intrarenal cause
19
Q
How does urine osmolality and urine Na in CHF secondary to AKI?
A
Urine osmolarity is high, urine Na is low as RAAS activated and Na+ increase with water
20
Q
Dipyridamole is used for?
A
Dilating coronary vessels, can catch coronary steal syndrome
For pharmacological stress testing
21
Q
Asthma findings?
A
decreased breath sounds, hyper-resonant (due to pulmonary hyperinflation), symmetrical chest expansion
22
Q
Lymph node and cell distribution?
A
Macrophages - medullary sinus
Plasma cells - medullary cords
Cortex - B cells
Paracortex - T cells
23
Q
SLE symptoms
A
Joint pain, muscle aches, severe sunburns, multiple non-tender superficial ulcers on oral mucosa, malar rash, alopecia, chelitis, raynaud’s
24
Q
MODY vs T1DM
A
MODY is dysfunctional beta cells of pancreas, so impaired secretion, whereas T1DM is autoimmune destruction of beta cells.
MODY II - glucokinase gene defect, MODY III - hepatocyte nuclear factor 1 alpha gene defect
MODY II - lifestyle modification, MODY III - must initiate sulfonylurea
25
congestive HF and renal arteriole changes?
Reduced renal perfusion, so stimulated RAAS, SNS and ADH, which will constrict efferent renal arterioles
26
Pyruvate dehydrogenase deficiency means you cannot take?
Glucogenic amino acids - alanine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, histidine, methionine, proline, serine, valine
27
Wernicke encephalopathy triad?
Oculomotor dysfunction, ataxia, confusion + alcoholic
28
Electrolyte changes for each diuretics
Loop - hypoK+, hypoMg2+, hypoCa2+
Thiazide - hypoK+, hyperCa2+
Aldo receptor antagonist - hyperK+
29
Types of incontinence?
Urge - sudden urge to pee, then immediately peeing
Stress - coughing, laughing then pee leaks out
Overflow - obstruction causing urine build up until cannot handle, which causes overflowing (hesitancy and trickling)
30
Simple cuboidal cells with smooth muscles in respiratory epithelium?
Simple cuboidal cell - bronchioles, smooth muscles - terminal bronchioles
31
Effacement of podocytes on electron microscopy, most likely finding on urinalysis?
MCD, fatty casts and albumin in urine
32
Rash and raised serum creatinine?
Allergic interstitial nephritis; urinary eosinophils seen
33
Increased D-dimer must always think of?
There is a clot that is being broken down
34
N. Meningitidis initial virulence factor
Adhesive pili
35
GCA Tx (glucocorticoids) can cause what changes to blood cells?
agranulocytosis and neutrophil leukocytosis
36
Dysgeusia (food tasting bland), alopecia, bulbous erythematous perioral plaques
Zinc deficiency, can cause acrodermatitis enteropathica
37
Injected conjunctivae, tender, erythematous nodules on both shins, bilateral hilar lymphadenopathy
Sarcoidosis, elevated CD4+ cell count due to non-caseating granuloma formation
38
TRALI pathophysiology?
Antibodies in donor activating host granulocytes (neutrophils)
39
If patient taking some meds take red wine, dried fruits, cured meat presents with HTN crisis, what meds?
MAO-I (I.e. Tranylcypromine), dangerous interactions with tyramine rich food
40
Esophageal epithelium?
Non-keratinised stratified squamous epithelium
41
Histo change during GERD?
Hyperplasia of esophagus and neutrophilic infiltrates
42
Maxillary prominence grow medially and fuse with lateral then medial nasal prominence - what is the underlying congenital defect?
Cleft lip
43
Systemic sclerosis symptoms and potential complications?
Symptoms - Sclerodactyly, raynaud’s, telangiectasia, GERD, dysphagia (esophageal smooth muscle fibrosis), myalgia, arthralgia, scleroderma
Complications - pulmonary fibrosis, P HTN, myocardial fibrosis, myocarditis, pericardial effusion
44
Why does increased hemoglobin breakdown cause H encephalopathy?
Hemoglobin breakdown increases production of ammonia and bilirubin, which all stresses liver
45
Vaginal discharge?
Malodorous grey, milky - bacterial vaginosis
Yellow green - trichomoniasis
Odourless and purulent - chlamydia, gonorrhoea
Thick white curd like - candidiasis
46
Fasting for 2 days. Primary energy source and most important enzymes?
Gluconeogenesis. PEPCK (phosphoenolpyruvate carboxykinase) is the most important enzyme.
47
Non-tender ulceration of penis followed by tender purulent nodules?
Lymphogranuloma venereum, caused by chlamydia
48
Lyme disease patient Abx?
Normal - tetracycline
Pregnant - penicillin
49
Oxaloacetate and acetyl-CoA will give citrate, require what vitamin?
Vitamin B5, pentothenic acid
50
Haemorrhoids blood supply and distributions?
External haemorrhoids - internal pudendal -> inferior rectal
Internal haemorrhoids - superior rectal
51
Baby comes in with bulging anterior fontanelle, bilateral retinal haemorrhage, fractures of ribs.
Shaken baby syndrome, shearing head injury - force that causes two layers to separate
52
Baby comes in with bulging anterior fontanelle, bilateral retinal haemorrhage, fractures of ribs.
Shaken baby syndrome, shearing head injury - force that causes two layers to separate
53
Opioid drugs MOA?
Close presynaptic Ca2+ channel, while opening postsynaptic K+ channel (hyperpolarise neurons)
54
crigler najjar syndrome lab findings?
Unconjugated bilirubin cross BBB, causing kernicterus
55
Function of GP120 protein on HIV?
Attach to CD4 receptor of T cells in host; this increases host range (can infect more)
56
SSRI predisposes patient to what condition?
SIADH
57
SIADH pathophysiology?
Posterior pituitary gland produce ADH, which will increase water reabsorption. -> RAAS switch off, but not enough to counteract. Hence, very concentrated urine (Urine Na+ increases)
58
Topoisomerase II inhibitors function?
Prevent stabilizing of double stranded break in DNA
59
Hearing loss, odd-eye, patchy hair loss in baby?
Waardenburg syndrome, which is due to neural crest defect
60
Metyrapone stimulation test?
Blocks conversion of cortisol
In normal people, sudden drop in cortisol will cause ACTH will increase
In adrenal insufficiency, already low cortisol so no change in ACTH
61
Rhinovirus virulence binds to what receptor in cell?
ICAM 1
62
Pneumothorax is associated with what physiological changes?
Shunting
63
Acanthosis nigricans associated with what conditions?
Obesity, PCOS, DM
64
Thayer-Martin agar is made of?
Heated sheep blood, vancomycin, nystatin, trimethoprim, colistin
65
Cardiac medication causing yellow vision with overdose?
Digoxin, causes hyperkalemia
66
Rash starting w head moving down to trunk, runny nose, cough, red crusty eyes (Coryza, cough, conjunctivitis)
Measles - Tx: symptomatic relief and Vitamin A
67
Alcoholic and diabetic patient, presenting with pneumonia with gram negative, catalase positive, capsulated bacteria.
Pseudomonas Aeruginosa
68
Recurrent infections, lymphadenopathy, inflammatory lesions caused by what disease?
Chronic granulomatous diseases; due to defective NADPH oxidase
69
Melanoma arises from what embryonic origin?
Neural crest
70
N gonorrhoea avoid immune response by?
Introducing variation of expressed adhesive pili protein
71
Upper UTO vs lower UTO Mx?
Upper UTO insert urethral stent; lower UTO place urethral catheter
72
Lung infection causes what changes?
Proliferation of TII pneumocytes
73
TNF alpha upregulation can cause what?
Increases risk of latent TB reactivation
74
snRNP will cause problems with what process?
Removal of introns
75
Sarcoidosis Tx?
Glucocorticoids (prednisone)
76
Patient presents with ataxia, orthostatic hypotension, livedo reticularis, peripheral edema after this drug toxicity . What is the drug?
Amantadine
77
MERRF pathophysiology?
Defective oxidative phosphorylation
78
Weight loss, recurrent fever, lymphadenopathy and HSM after coming back from Africa. Where did he get the disease from?
Sand fly
79
Weight loss, recurrent fever, lymphadenopathy and HSM after coming back from Africa. Where did he get the disease from?
Sand fly
80
Lactose intolerance will cause what physiological change?
Decreased pH, increased stool osmotic gap
81
Unilateral small kidney with HTN?
Renal artery stenosis
Renal artery stenosis causing activation of RAAS, which increases BP
82
Unvaccinated child with flaccid paralysis?
Polio
83
Acute Hep B Tx?
Symptomatic treatment
84
Secreting Abx require what kind of binding?
B cell activation, so CD40 to CD40L
85
Pt comes in with AVRNT. What kind of maneuvers can you do?
Carotid artery massage (stimulates CN IX) and valsalva maneuver
86
Bone healing involves what cytokines?
Macrophage colony stimulating factor
87
Well differentiated endometrial carcinoma with increased inhibin levels. Dx?
Granulosa cell tumour
88
Clustered amorphous microcalcification of breast. Dx?
Ductal carcinoma in situ
89
How does MRSA develop resistance to penicillin?
Alters PBP binding site to prevent penicillin from attaching to itself
90
Oligomenorrhoea with low progesterone levels for adolescent girl. Dx?
Anovulatory cycle due to immature hypothalamic -> pituitary -> gonadal axis
91
Wet AMD Tx that is also used to treat RCC?
Bevacizumab (prevents neovascularisation)
92
Mushroom consumption -> bloody diarrhoea, AST/ALT raised to a few thousand, inhibition of what is causing the Sx?
mRNA synthesis
93
Painless neck swelling that becomes painful with alcohol consumption, giant binucleate cells (owl eye)?
Hodgkin lymphoma
94
PCR requires what substance?
sequencing of 3’ end of DNA strand by primers
95
Blue stain on microscope showing dark blue specks on RBC. What is that blue speck?
Ribosomal RNA
96
Erythematous rash with yellow scales, erythematous throat and swollen tongue - deficiency of what?
Vitamin B2 (Riboflavin)
97
Cloudy joint fluid, normal leukocyte count, swollen, painful knee. Dx?
Pseudogout. Calcium pyrophosphate dehydrate crystal
98
Drug used to treat androgen sensitive prostate cancer that causes increase in testosterone and DHT, before reducing their lvls
Leuprolide
99
Tx for DI?
Central - desmopression
Nephorgenic - thiazides and NSAIDs
100
Hairy cell leukemia Tx?
Cladribine, resistant to breakdown by ADA
101
Painful circular ulcer, surrounding erythema and central black eschar causing organism and virulence factors?
Pseudomonas aeruginosa, exotoxin A
102
Negative nikolsky, pruritic bullae
Bulbous pemphigoid, affects dermoepidermal junction
103
Male characteristics, undescended testes, ambiguous genitalia -> male genitalia during puberty?
5 alpha reductase deficiency
104
Glucocorticoids MOA?
Inhibits transcription factors like nuclear factor kappa B
105
Miultiple myeloma causes renal failure by?
Excessive precipitation of Ig light chains
106
Multiple sclerosis findings on microscope?
Eosinophilic intracytoplasmic inclusion body
107
BMPR2 gene
Pulmonary arterial HTN
108
Viral encephalopathy causing neuro Sx?
HSV
109
Itchy rash and weight loss, palpable lymph nodes?
Cutaneous T cell lymphoma - CD4+ ce;;s with cerebriform nuclei
110
Small round blue cells, lytic lesions in diaphysis of femur and surrounding cortex covered by several layers of new bones
Ewing sarcoma
111
Chocolate agar
H influenzae
112
Wuchereria bancrofti etiology?
Deposition of larvae into skin by female mosquito; causes elephantiasis
113
Infundibular stalk obstruction will cause what hormone changes?
Block in GnRH, CRH, TRH, GHRH, somatostatin, dopamine
This will result in rise of GH and prolactin
114
Immune cells that lyse abnormal cells without needing to opsonise, prime or activate?
NK cells
115
HOCM presentation
Mitral valve systolic anterior motion, asymmetrical septal hypertrophy, septal wall thickness of >15mm
116
PTH hormone MOA on bone resorption?
RANKL expression of osteoblast; induced IL-1 expression of osteoblast, which both activates osteoclast
117
Most commonly injured site in prostatectomy?
Cavernous nerve
118
Most common illness causing MS?
RHD, which is an antibody cross reactivity (type 2 hypersensitivity)
119
Mass seen after overuse?
Myositis ossificans
120
RA patient comes in with mouth ulcers, what could be the cause?
Methotrexate use, which causes folate deficiency, which results in deficient nitrogenous base production and megaloblastic anemia
121
Clustered cuboidal foamy appearing cells in lungs
Type 2 pneumocytes
122
Transmembrane efflux pump protein causing reduced intracellular concentration of chemotherapy drugs?
Multidrug resistant protein 1 (P-glycoprotein)
123
Middle meningeal artery enters from what foramen?
Foramen spinosum
124
Patient increased fetal loss risk, super high platelets, Hx of DVT
Essential thrombocythemia
125
Drug that inhibits both factor Xa and thrombin
Heparin (activates antithrombin)
126
CMV can cause what complications in immunocompromised individuals?
Linear ulcers at lower esophageal sphincter
127
Painful genital ulcers + tender inguinal lymphadenopathy
Haemophilus ducreyi
128
Azathioprine will not be as effective in patients with what enzyme deficiency?
HGPRT
129
Diffuse eosinophilic scarring of terminal bronchioles + luminal obliteration by granulation tissue
Bronchiolitis obliterans (chronic graft rejection)
130
T1DM inheritance pattern
Polygenic
131
Actinic keratoses increases risk of what?
Squamous cell carcinoma
132
Goodpasture’s disease is type what hypersensitivity?
Type 2 hypersensitivity
133
Bartonella gives rise to what disease?
Bacillary angiomatosis and cat scratch disease
134
Central stellate scar renal cancer?
Oncocytoma
135
Diabetic neuropathy pathophysiology?
Increased protein deposition on endoneural vessel walls
136
Recurrent blood transfusion can lead to what?
Macrophages with cytoplasmic granules that stain golden yellow with hematoxylin (hemosiderin deposits - too much blood cells dying)
137
If patient cannot tolerate first line antipsychotics (i.e. haloperidol, fluphrenazine), second line?
Chlorpromazine, thioridazine
138
Long head of the bicep femoris + semitendinosus origin
Ischial tuberosity
139
Peutz-Jeghers syndrome associated with?
Gastric cancer, small intestine and colon CA, together with pancreatic CA
140
Spindle shaped cells for ovarian tumour
Ovarian fibroma
141
Kentucky fungus
Blastomycosis
142
What allows for cancer metastasis?
Overproduction of proteases like collagenase and metalloproteinase
143
Post menopausal woman, breast CA, vaginal dryness, bone density drop
Aromatase inhibitor (exemestane, anastrozole, letrozole)
144
Kenya migration, splenomegaly, SCC of bladder, diagnosis?
Schistosomiasis, also can cause lung complication (pulmonary HTN)
145
What other hormones are secreted together with melanin secreting hormones?
ACTH and endorphins
146
Patients undergoing Whipple procedure at highest risk of what deficiency?
Iron deficiency, so can present with microcytic anemia
147
Why can rapid recovery happen with short acting sedatives?
Redistribution to body
148
HIV and HHV8 lesions means?
Kaposi sarcoma, which presents with spindle cells with lymphocytic infiltration
149
Sensation to the ear
CN X
150
Hilar lymphadenopathy and well defined nodules + central calcifications. Basophilic, crescent shaped nuclei with pericellular halos in macrophages.
Histoplasma capsulatum; check for bat dropping exposure
151
Acute on chronic hip pain, restricted internal rotation and abduction
Slipped capital femoral epiphysis (unstable proximal femoral growth plate)
152
Mumps complications
Parotidomegaly, orchitis
153
Cocaine during pregnancy can cause?
Premature delivery
154
RPGN crescent cell pathophysiology?
Too much fibrin deposit
155
APML treatment?
Trans-retinoic acid
156
Patient just has all sorts of infections
SCID, caused by IL-2 receptor gamma chain defect
157
TB drug that targets intra-macrophage TB
Pyrazinamide
158
Why is there an increased lactic acid due to shock?
Anaerobic respiration happens due to NADH accumulation
159
Difference between measles and rubella presentation?
Measles - high fever, runny nose, conjunctivitis, koplik spot
Rubella - Retroauricular rash, pink eye, headache, rash behind ears that developed into maculopapular exanthem, lymphadenopathy (postauricular and occipital)
160
Polymyositis pathophysiology
Sarcolemmal MHC-I overexpression with CD8+ lymphocytic infiltration
161
Toxic shock syndrome by Staph A
Binds to Fc region of IgG
162
Neutropenia predisposes to what infections?
Enteric bacterial infections
163
Patient with cancer, present with hematuria
Tumour lysis syndrome; treat with recombinant uricase (oxidation to allantoin)
164
Deteriorating hearing, vision, motor ability and cognition with other people in the family having same issues
Adenoleukodystrophy (Peroxisomal ATP-binding cassette transporter deficiency)
165
DM in pregnant women
Give insulin (Binds to tyrosine kinase receptor)
166
DM and HTN arteriolosclerosis
DM - hyaline arteriolosclerosis
HTN - hyperplastic arteriolosclerosis
167
Petting zoo causative organism?
Campylobacter jejuni (gram neg, flagellated bacteria that does not ferment lactose)
168
Fusion of host cell and HIV cells require?
CD4 receptor and CCR5 or CXCR4
169
Most common cause of death in cystic fibrosis patients?
Pulmonary infections
170
Congenital adrenal hyperplasia, what enzyme is the patient deficient in?
11 beta-hydroxylase deficiency; which converts 11-deoxycorticosterone to corticosterone
171
Adrexal mass + hyperthyroidism
Germ cell tumour
172
Prostate cancer treatment that also help with hair regrowth
Finasteride; 5 alpha reductase inhibitor
173
Recurrent respi patho + GI patho for a young child signifies?
IgA deficiency; puts the child at risk to HSR to transfusion
174
DM drug that prevents carbohydrate bond breaking?
Miglitol, acarbose
175
Turner syndrome pregnancy success rate?
With donor oocytes, same as those with primary ovarian failure
176
HIV prophylaxis prenatally
Zidovudine
177
Pre-eclampsia pathophysiology
Abnormal spiral artery remodelling
178
Lung scar tissue increases risk of what lung malignancy?
Adenocarcinoma
179
Headache, muscle pain, recurrent fever spikes without pattern
Plasmodium falciparum (Malaria)
180
Beyond a certain amount of PAH, effective renal flow of PAH will fall. This is because?
There is a decreased clearance of PAH
181
Aplastic anemia
Fat deposition in the bone marrow
182
HIV patient with multiple firm violaceous nodule causative organism?
Bartonella henselae (bacillary angiomatosis)
183
IVDA and hepatitis, two organisms (One double stranded DNA genome, one single stranded RNA genome)
Deltavirus (HBV and HDV)
184
Scarlet fever pathophysiology?
Erythrogenic toxin induced cytokine release
185
Karyotypical female presents with ambiguous genitalia
Aromatase deficiency
186
Leukocytosis, elevated leukocyte alkaline phosphatase, elevated myeloid lineage cells
Leukemoid reaction
187
GBS spinal CSF tap
Very high protein without changes in WBC, glucose or opening pressure
188
Swallowing innervation?
CN X
189
How to confirm primary hypercortisolism?
CT abdomen
190
Congenital hypothyroidism presents with?
Poor feeding and lethargy, hoarse cry, jaundice, macroglossia, hypotonia
191
Decreased libido, secondary amenorrhoea, vision loss, hyperprolactinemia. Dx?
Prolactinoma, which can be treated by bromocriptine
192
Hep C drug therapy
Interferon alpha and inosine monophosphate dehydrogenase (ribavirin)
193
Shigella causes bloody diarrhoea by?
Invading colonic microfold cells
194
Retinal haemorrhage, blurred vision and flashing light in immunocompromised patient
CMV; treat with foscarnet
195
Adverse effects of chemotherapy
Kills off rapidly dividing cells (i.e. intestinal epithelial cell, hematopoietic stem cell, gonadal germ cells)
196
Multiple myeloma is associated with
Amyloidosis
197
IL-6 function is to?
Stimulate synthesis and secretion of positive acute phase protein like fibrinogen
198
How to fix spastic neurogenic bladder? (Internal sphincter and detrusor contract same time)
Prazosin
199
Aortic stenosis most common cause
Below 70: bicuspid aortic valve
Above 70: calcification
200
Kidney dialysis patient presenting with bleeding problem
Uremia - platelet aggregation dysfunction
201
Right heart hypertrophy with familial symptoms
Pulmonary arteries hypertension (BMPR2 gene mutation)
202
Pus in abscess primary IL involvement?
IL-8
203
Foul smelling, dark red, currant jelly sputum, gram negative rods
Capsular polysaccharide
204
Remyelination process
Increased transmembrane resistance, which allows for increased length constant
205
Naegleria fowleri route of infection (Hot spring - warm freshwater)
Penetration of cribiform plate
206
HSV is what type of virus
Enveloped, double stranded, linear DNA
207
Angular cheilitis and pica (keep eating non-nutritious substance)
Iron-deficiency anemia; also presents with spoon shaped nails (Koilonychia)
208
Virus retains own genetic material but coated with surface protein of different coinfecting virus
Phenotypic mixing
209
Nephrotic syndrome, HSM, Crohn’s, carpal tunnel syndrome
Amyloidosis
210
AUG -> UUG
Affects binding of met-tRNA to 60S complex (Stop codon -> start codon)
211
bluish brown sclerae, dark sweat stain, thickening of ear cartilage (Ochronosis)
Alkaptonuria (Tyrosine metabolism disorder)
212
6-MP and what drug when administered together can cause toxicity?
Febuxostat
213
Goblet cell function?
Increased mucous secretion
214
Neurofibromatosis type II presents with?
Meningioma, bilateral vestibular schwannoma, spinal tumour
215
Baby with hypoxia, rapid breathing, ground glass opacities
Neonatal respiratory distress syndrome - Hyaline membrane lining alveoli on lung biopsy
216
Substance abuse causing patient to be irritable, rapid breathing, dilated pupils
Activation of SNS, so amphetamine
217
Patient taking azithromycin sudden palpitation
Prolonged QT - torsades de pointes
218
Nonproductive cough showing disc-shaped yeast cells
Toxoplasmosis
219
Porphyria cutanea tarda
Uroporphyrinogen III decarboxylase
220
Bladder cancer calcium issue
Due to PTHrH secretion, Ca2+ increases and phosphate decreases
221
Schistocyte will cause what in serum to rise
Lactate dehydrogenase
222
Osteosarcoma and sensorineural hearing loss
Paget’s disease of the bone
223
Hep B virus with high infectivity
Tenofovir
224
CMV pharmacotherapy?
Valganciclovir
225
CMV pharmacotherapy?
Valganciclovir
226
Clostridium perfringens virulence
Alpha toxin that degrades cell membrane w phospholipase
227
Ulcers, sore throat, fever and neutropenia after dual antiplatelet medication
Ticlopidine
228
Pancreas pseudocyst consists of?
Granulation tissue
229
Holosystolic murmur and diastolic rumble best heard at apex?
VSD; which will lead to RVH -> reversed shunt -> hypoxemia (clubbing)
230
Bortezomib MOA
Accumulation of ubiquitinated proteins
231
Livedo reticularis, erythematous, tender subcutaneous nodules on LL, renal artery stenosis. DDx?
Polyarteritis nodosa - transmural inflammation with fibrinoid necrosis on arterial biopsy
232
Koilocytes are indicative of?
HPV infections - Cervical cancer; condyloma acuminatum etc.
233
Main glucose source after 24 hours of fasting onwards
Hepatic gluconeogenesis; involved enzyme: pyruvate carboxylase (which needs Acetyl CoA)
234
DLCO is increased by?
exercise, supine position, pregnancy, obesity
235
Preterm infant; chorioamnionitis; Bulging anterior fontanelle, hypotonia, changes in eye movement, sluggish pupillary reaction
Intraventricular haemorrhage (Germinal matrix!!!)
236
VHL disease associated with
Hemangioblastoma, bilateral RCC, pheochromocytoma, renal/pancreatic cysts
237
Chloramphenicol can cause?
Aplastic anemia; it inhibits peptidyltransferase at 50s subunit
238
Septate hyphae that branch at 45 degrees?
Aspergillus
239
Asthma, eosinophils, IgE, septate hyphae branching at 45 degrees?
ABPA - IL-4 mediated (IgE)
240
Increased leukocyte count without rise in monocytes?
Filgrastim
241
Common peroneal nerve innervates?
Dorsiflexion of foot
242
Numbness and tingling everywhere
Paraneoplastic syndrome
243
Where does Ca2+ ion bind to myocyte actin filament?
Troponin C
244
Arteries that branch
L1 - SMA
L2 - gonadal arteries
L3 - IMA
L4 - bifurcation of common iliac
245
HSV drug?
Acyclovir - can cause crystalline nephropathy
246
Protect effectively against photoaging?
Zinc oxide / titanium oxide
247
Late complication of T2DM?
Incomplete bladder emptying (diabetic autonomic neuropathy)
248
What works on both thymine and uracil?
DNA polymerase I
249
Thermoregulator in body?
Preoptic nucleus in anterior hypothalamus
250
Viral infection, the present with enlarged cardiac silhouette
Elevated BNP concentration on serum studies (viral myocarditis)
251
Flank pain and muscle involvement
Most likely psoas major
252
Tetracycline MOA?
Aminoacyl-tRNA to mRNA-ribosome complex
253
Fracture at sphenoid bone cause which CN nerve lesion?
CN6 ( inward deviation of eye)
254
Adolescent athlete with knee pain (overuse)
Traction apophysitis of tibial tubercle
255
Acute rheumatic fever
M protein
256
Streptomycin resistance
Alteration of 30S ribosomal subunit
257
What requires uracil to function?
Primase
258
LEMS pathophysiology?
Anti-presynaptic Ca2+ channel Ab in serum
259
Thymoma is mostly present in?
Patients with MG - ACh receptor Ab used to check for MG
260
H influenza prophylaxis?
Rifampin
261
Chronic mucotaneous candidiasis
AIRE gene mutation; T cell dysfunction
262
Urinary incontinence due to nerve damage will be followed by what symptoms?
Absent reflex erection; perineal hyperesthesia, absent anal sphincter contraction
263
Primary sclerosing cholangitis will show what kind of liver biopsy specimen?
Periductal concentric scarring and fibrosis of bile duct
264
Hyperacute graft rejection
Antibody against HLA class I molecules
265
Hyperacute and chronic transplant rejection type of tissue change?
Hyperacute: fibrinoid necrosis
Chronic: interstitial fibrosis
266
Gardener present with pustules that becomes nodules and ulcers
Sporothrix schenckii
267
Lipofuscin granules
Caused by wear and tear; cellular pigment that results from deposition of lipid containing, lysosomal degradation product in tissue (increases with age and cause yellow brown deposits on histopathologic exam)
Secreted in apocrine gland lead to chromhidrosis
268
Hypoesthetic, hypopigmented macular lesion from a patient in developing country
Leprosy (Mycobacterium leprae)
269
JVP elevation, headache, dysphagia, dyspnoea
SVCO due to lymphoma
270
Rheumatoid factor is?
IgM autoantibodies that bind to Fc region of IgG
271
Hip pain and decreased hearing
Paget disease of the bone - also known as osteitis deformans
272
Cervical cancer mets?
To nearby structures - i.e. bladder (postrenal azotemia)
273
Carfilzomab
Proteasome inhibitor - decrease activation of CD8+ T cells
274
MEN1
Pituitary adenoma (infertility treated with bromocriptine), parathyroid adenoma, gastrinoma
275
Spinal cord degeneration, hypertrophic cardiomyopathy, insulin dependence
Friedreich ataxia (GAA on chromosome 9)
276
Km vs Vmax
Km - substrate concentration when reaction rate is half of Vmax
Vmax - maximum rate of an enzyme catalysed reaction when enzyme is fully saturated with substrate
277
Pure Vmax increase?
Increase in enzyme concentration
278
Anaplasia
Loss of function of cell - so original cell is no longer there
279
Depressed patient suddenly showing manic symptoms after starting this drug?
Venlafaxine
280
Cartilage regeneration occurs in the?
Perichondrium
281
High calcium, low PTH hormones, low urinary calcium level
Familial hypocalcinuria hypercalcemia - defect in calcium sensing receptors
282
Baby presenting with hypopigmentation, seizures, hypotonia, eczema, musty odour
Phenylketonuria (PKU); phenylalanine hydroxylase
283
DKA patient with rhino-orbital-cerebral infection
Rhizopus microsporus
284
High pitch problem arises with which muscle?
Cricothyroid - 4th arch
285
Binding of what to myosin heads lead to myosin detachment from actin?
ATP
286
T2DM neuropathy pathogenesis
Accumulation of islet amyloid polypeptide
287
Accidental disclosure of patient info to investigators
Pygmalion effect
288
What is the cushing triad
Bradycardia, respi depression and HTN
289
Mannitol can lead to what adverse effects?
P edema
290
Patient went to Oklahoma, flu like symptoms and neurological symptoms, leukopenia, thrombocytopenia
Ehrlichia chaffeensis
291
PCT damage after chemo agent reversed by?
amifostine
292
Hairy cell leukemia
Neoplastic lymphocytes that stain positive for tartrate-resistant acid phosphatase
293
Fc region of IgG antibody is responsible for?
Complement fixing
294
Turner syndrome most common complications
Osteoporosis
295
High AFP and AChE in baby, polyhydroamniosis
Anencephaly
296
Low grade fever, slapped cheek, lacy maculopapular rash
Parvovirus B19 - erythema infectiosum
297
What anti-inflammatory arrests chromosomes in metaphase?
Colchicine
298
Leukocyte count elevated and seizures
Viral encephalitis, necrosis of temporal lobes
299
Administration of insulin will cause what kind of biochemical change?
Dephosphorylation of FBP
300
Left heart failure vs right heart failure - pulmonary arterial pressure and PCWP
LHF: P arterial pressure elevated, elevated PCWP
RHF: P arterial pressure elevated, normal PCWP
301
Snake venom exposure; fever, itchy rash, proteinuria
Serum sickness, would see hypocomplementemia
302
Walls are growing, flowers seem bright, not oriented to time
Lysergic acid diethylamide (LSD)
303
Early wound healing vs late would healing
Early wound healing - type III collagen (reticular fibres)
Late wound healing - type I collagen (lens, dentin, cornea etc.)
304
GCA treatment if refractory to corticosteroids?
Tocilizumab (IL-6 receptor inhibitors)
305
Combined oral contraceptive pills protective effect
Ovarian tumour
306
Gram negative rod that ferment lactose
E coli - heat labile toxin
307
D-xylose test functions
Differentiate between small intestinal absorption and differentiate between mucosal malabsorption
- normal (pancreatic insufficiency) vs low (intestinal mucosa issue)
308
Sclerosis, cortical destruction and new bone formation; spiculae formation
Osteosarcoma in the periosteum (sunburst appearance)
309
Pioglitazone MOA?
Increased transcription of adipokines (PPAR-gamma)
310
Intra-abdominal adhesion and dilatation of renal pelvis and proximal ureters bilaterally
Increased hydrostatic pressure of tubules leading to decreased GFR
311
What process occurs in germinal centre?
Isotype switching
312
Invasive ductal carcinoma overexpression of what gene?
ERBB2
313
Why is carbidopa always administered together with levodopa?
Prevent orthostatic hypotension
314
Breast mets to spine via
Azygous vein
315
Isotretinoin works similarly to drug fixing what?
APML - uses all-trans retinoic acid
316
Upper GI tumour staining positive for CD20 antigen?
MALT - risk factor: H pylori
317
Elderly pt anemia, leukopenia, splenomegaly and teardrop cells, JAK2 mutation
Primary myelofibrosis - Fibrosis of bone marrow
318
Sickle cell disease findings in RBC
Nuclear remnants in erythrocytes
319
MEN2B symptoms
Marfanoid habitus, medullary thyroid carcinoma, mucosal neuroma, pheochromocytoma
320
Mucoid grey-white colonies; Eosin methylene blue agar grows purple colonies with no metallic green sheen
Klebsiella pneumoniae
321
Parrot disease
Chlamydia psittaci
322
SCLC will stain positive for?
Neuron specific enolase
323
Macroglossia, hypotonia and cardiomegaly in infant
Pompe disease; lack of acid maltase
324
Elastin’s elastic properties are contributed by?
Crosslinking of lysine residue
325
Hypoglycemia, hepatomegaly, hypercholesterolemia, hyperuricemia, lactic acidosis
Von Gierke disease
326
Lyme carditis treatment?
Ceftriaxone
327
Bronchiectasis features
Tram track opacities, honeycombing, copious sputum, digital clubbing
328
Guatemala travel, macrophages with amastigotes
Leishmania braziliensis
329
Why is there ventricular dilation in alzheimer’s patients?
Atrophy of cortex, so ventricles expand to fill volume occupied by cortex
330
Fatigue, irregular menses, recurrent sinus infections, hirsutism, hypopigmented linear striation, hyperNa+, hypoK+, metabolic alkalosis, cortisol and ACTH elevated. Dx?
Endogenous hypercortisolism
331
Cancer patients presenting with temporal wasting
Cachexia, due to proteasome-ubiquitin protein degradation
332
Cancer drug that causes ototoxicity?
Platinum based drugs - cause DNA cross-linking
333
Acute tubular necrosis attacks the straight segment or convoluted segment first?
straight segment
334
Klinefelter syndrome blood smear shows?
Barr body, which is methylation of cytosine nucleotide
335
Appendix testis is formed by?
Sertoli cells
336
Pseudomonas aeruginosa first line Abx?
Cefepime and levofloxacin
337
Rocky mountain spotted fever symptoms?
Tick borne disease, caused by rickettsia rickettsii, macular and petechial rash on ankles and wrists
338
What drug increases IP3 concentration in arteriolar smooth muscle cells and increase cAMP concentration in cardiac myocytes? Negligible effect on cAMP concentration in bronchial smooth muscle cells.
Norepinephrine
339
PCOS symptoms?
Hirsutism, acne, weight gain, elevated testosterone, LH: FSH ratio > 2:1
340
First line Tx for PCOS?
Clomiphene, which is a hypothalamic estrogen receptor inhibitor
341
ANP and BNP function?
Opposite of RAAS, decreased reabsorption of sodium (natriuresis and diuresis - increases Na+ and water excretion), inhibits renin secretion
342
HIV infection Tx indinavir adverse effect
Urolithiasis
343
Well-demarcated, homogeneous, hyperechoic mass on liver US
Cavernous hemangioma
344
Cavernous hemangioma biopsy adverse effect?
Intraperitoneal haemorrhage
345
Acute Hep A finding
Councilman bodies (apoptotic hepatocytes - shrunken, eosinophilic cytoplasm and pyknotic nuclei)
346
Bleomycin acts on which phase of cell cycle?
G2 and M
347
Hemolytic anemia in child with extramedullary haematopoiesis?
Beta thalassemia
348
Obese patient with lateral hip pain?
Greater trochanteric pain syndrome
349
Giemsa stain positive pneumonia causing agent?
Chlamydophila pneumoniae
350
SvO2 low means?
Pulmonary artery oxygen saturation is low, mostly seen in anemia
351
Blood vessels and lymph nodes are derived from?
Mesoderm
352
Pregnant women with low milk production and low TSH and T4?
Pituitary ischemia
353
Fluoxetine cannot be taken with what cough medicine?
Dextromethorphan, as it is a serotonergic agent
354
Anidulafungin, caspofungin, micafungin MOA?
Decreased glucan synthesis
355
Why does tertian malaria keep recurring?
Reactivation of dormant liver stage
356
Nocardia strongest predisposing factor?
Exposure to contaminated soil
357
Pus is made of?
Lysosomal enzymes made from neutrophils and macrophages
358
Cold AIHA patients most exposed to what LRTI organism?
Mycoplasma pneumoniae
359
Difference between IgA transfusion hypersensitivity vs acute hemolytic transfusion reactions
IgA - type 1 so would have things like urticaria, angioedema
AHTR - positive direct coombs test; donor RBC lysis due to preformed antibodies in patient serum
360
Leukocyte adhesion deficiency type 1
Autosomal recessive defect in CD18 (beta-2 integrin)
361
Bile acid sequestrants cause what changes in LDL, HDL and TG levels?
LDL decreases, HDL increases, TG increases
362
Hep B infection and p-ANCA negative vasculitis?
Polyarteritis nodosa
363
aggregation of globoid cells and loss of glial cells
Krabbe disease
364
single strand positive sense RNA virus
HIV
365
What kind of cells does HIV infect?
affects langerhans cells
366
most common meningitis causing bacteria?
Strep pneumo
367
Homonymous hemianopsia occurs in damage to?
Optic tract
368
pregnant woman overuse of HTN drug causing headache, tachycardia, pitting edema of both lower extremities
hydralazine (direct arteriole dilation)
369
where is the site of injury in the urethra when you hit the genitals?
bulbous urethra
370
Meiosis to resume and loss of gap junction between the granulosa cells and oocytes refers to?
Ovulation
371
Drug that promotes ovulation?
Human chorionic gonadotropin
372
During hysterectomy, which vessel should be ligated to achieve hemostasis? And where is this vessel located in?
Uterine artery, located in cardinal ligament
373
Why is there higher insulin resistance with high lipid diet?
There is an increased activity serine kinases
374
Abx that causes unpleasant metallic taste in mouth?
Metronidazole
375
Metronidazole covers for which STI?
Trichomonas vaginalis
376
A lot of superficial ulcers in distal esophagus in HIV patients?
Esophagitis caused by HSV
377
Most common cause of death of patients with FA?
Heart failure
378
Patient BPH but have HTN, give what drug?
Terazosin
379
Anosmia and delayed puberty due to what pathophysiology?
Kallmann syndrome, impaired migration of GnRH neurons during embryogenesis
380
Diabetes and neuropathy syndrome stem should always be
Polyneuropathy
381
Chvostek sign is?
Tapping on cheeks causing contraction of facial muscles, usually seen by hypocalcemia patients
382
How does massive blood transfusions lead to hypocalcemia?
Blood transfusion will lead to chelation of calcium, as there is a lot of citrate in transfusion blood
383
Valganciclovir adverse effects?
Bone marrow suppression (pancytopenia)
384
Acyclovir adverse effect
Crystal nephropathy
385
How do I reach R bronchial artery from thoracic artery?
Thoracic artery -> posterior intercostal artery -> bronchial artery
386
Restrictive lung disease with hyperCa2+
Sarcoidosis
387
Sarcoidosis will lead to high ACE activity as?
Noncaseating granuloma in the lungs will secrete ACE
388
Pancytosis is seen in what blood disorder?
Polycythemia vera
389
JAK2 gene encodes for?
Nonreceptor tyrosine kinase
390
Mild hemophilia A is treated with
Desmopressin (vasopressin analogue)
391
Yersinia enterocolitica transmission via
Undercooked pork, unpasteurised milk product, unfiltered water, pet faeces
392
Raloxifene adverse effects?
Pulmonary embolism
393
Buzzword - atypical lymphocytes; amoxicillin rash
Infective mono due to EBV
394
How do you diagnose infective mono?
EBV is diagnosed by anti-VCA IgM
395
Salmonella antibiotic therapy will lead to?
Prolonged excretion of pathogen
396
What is released during type 1 hypersensitivity reactions?
Histamine, tryptase, heparin, eosinophil chemotactic factors
397
Alzheimer disease treatments are rivastigmine, donepezil and galantamine, which are all?
AChE inhibitors, so to reverse their adverse effects, you must add atropine
398
Wrinkled paper like mononuclear cells
Gaucher disease, which is glucocerebrosidase deficiency
399
Anorexia can result in what changes in thyroid hormones
Decreased T3
400
Lorazepam MOA?
Allosteric activation of GABA-A receptors to increase frequency of GABA release
401
Hypothyroidism Sx?
Myopathy, weight gain, amenorrhoea, cold, dry skin
402
Aspiration pneumonia area
Superior of R lower lobe
403
Hepatic lesion with hyperemic rim (surrounding edema and inflammation)
Liver abscess
404
Beta-pleated linear sheet infiltration
Amyloidosis
405
Amyloid deposit in seniors
Transthyretin
406
Newborn present with asymmetry of the thigh most likely due to?
Abnormal development of acetabulum
407
Lung air fluid level, most common organism?
Lung abscess mostly caused by S aureus
408
Increased resting and squeezing tone of anus. DDx?
Voluntary relaxation of levator ani (pubococcygeus, iliococcygeus and *puborectalis*) muscle issue
409
Lipodystrophy causing HIV drug?
Indinavir
410
How do you end up having pneumobilia?
If there is chronic inflammation of gallbladder, there is adhesion between intestine and gallbladder
411
What Abx does resistance develop with phosphorylation, acetylation or adenylation?
Aminoglycosides
412
Increased propionic acid in urine
Maple syrup urine disease, caused by increased breakdown of branched chain AA
413
Genetic disease showing ragged red fibres?
Mitochondrial Encephalomyopathy, Lactic Acidosis, Stroke-like episodes (MELAS)
- could show milder presentation with hetero mitochondrial DNA
- ragged red fibres are due to compensatory proliferation of mitochondria
414
Patients cannot restart OCPs if they are?
Thrombotic - Smokers (above 35 smoking above 15 sticks), IHD, severe HTN, coagulopathy, breast cancer, cirrhosis
**have migraines with aura
415
RSV treatment
Rivabirin and palivizumab
416
Spontaneous bacterial peritonitis treatment
Cephalosporin - bacterial peptidoglycan cross-linking inhibitors
417
Stabbed in left thigh, present with pulsatile mass, thrill and bruit
Atrioventricular fistula - could lead to high output cardiac failure
418
Lithium toxicity can be precipitated by?
Renal impairment (ACE-I, NSAIDs, CKD) or volume depletion
419
Most common cause of CN3 palsy?
PCA aneurysm
420
Homocysteinuria patients Tx?
B6 supplement
421
Heparin + thrombocytopenia is due to?
Formation of antibodies against heparin-PF4 complex
422
Pyelonephritis first line Tx?
Fluoroquinolones (topoisomerase II and IV inhibitors)
423
ATP mostly works in where in muscle cells?
A bands
424
Hyperacute rejection, acute rejection and chronic rejection of organ transplant
Hyperacute - antibody
Acute - CD8+ T cells
Chronic - CD4+ T cells
425
Burr cells (echinocytes - jagged RBC) and newborn showing jaundice
Pyruvate kinase deficiency (reduction of ATP generation due to less conversion of PEP to pyruvate; in this process ADP -> ATP)
426
For AST and ALT, what enzymes are important for transamination?
B6 (pyridoxine)
427
Young boy present with seizure, cardiac issue, multinodular, calcified lesion in retina, ash leaf spot
Tuberous sclerosis (chromosome 9 and 16)
428
First physiological response to excessive blood loss?
Increase of HR
429
Local anaesthetics MOA
Bind to voltage gated Na+ channels and reversibly block Na+ channels, inhibit nerve excitation
430
Dimorphic fungus that is hyphal form at 25 degrees, cigar shaped budding yeast at 37 degrees
Sporotrichosis
431
Fluoroquinolones cannot be administered together with?
Multivitamins (have metals inside)
432
Sickle cell disease drug that can cause macrocytosis?
Hydroxyurea, inhibits ribonucleotide reductase that causes cell cycle arrest in S phase
433
Granuloma pathophysiology? (either sarcoidosis or TB)
CD4+ cells activated, which secretes Th1 cytokines (IFN gamma), causing macrophage to secrete TNF alpha
- just know that TB is caused by infection, and sarcoid is abnormal CD4+ cell
434
Uncal herniation will lead to?
Ipsilateral oculomotor nerve compression, cortical blindness, contralateral homonymous hemianopsia, ipsilateral paralysis
435
Tonsillar herniation
Altered mental status, cardiorespi depression
436
Subfalcine herniation Sx?
Contralateral LL weakness
437
Central transtentorial herniation
Extensor posturing (decerebrate posture), altered mental status
438
Extracranial herniation
Skull fracture and focal neurological defects
439
Paget disease of the bone
Normal Ca2+, normal Phosphate, elevated ALP and normal PTH
440
Pseudomonas produces what substance?
Pyoverdine and pyocyanin
441
Different stones in the gall bladder pathophysiology (cholesterol, black pigment, brown pigment)
Cholesterol stones - due to abnormal cholesterol metabolism
Black pigment stones - excessive hemolysis
Brown pigment stones - due to biliary infection or infestation, increased beta glucuronidase
442
Young boy with heme disorder passed down, increased RCDW and MCHC
Hereditary spherocytosis - diagnosed by eosin-5-maleimide binding test
443
CNVII muscle innervation
Facial muscle, platysma, posterior belly of digastric, stylohyoid, stapedius
444
Systemic sclerosis Sx?
Calcinosis cutis
Raynaud’s
Esophageal hypomotility
Sclerodactyly
Telangiectasia
+ pulmonary fibrosis, myocardial fibrosis, renal arterial HTN, renal insufficiency
445
Sertoli cell insufficiency means?
Decreased inhibin B concentration - usually seen in cryptorchidism
446
Most common cause of SIADH is?
Medication effect (SSRI, carbamazepine, cyclophosphamide)
447
CLL marker
Smudge cells
448
Teardrop cells are seen in?
Extramedullary erythropoiesis
449
Multiple myeloma markers
Rouleaux formation (stack of coin appearance)
Hypergammaglobulinemia
450
Bilateral non-pitting edema is a buzzword for?
Lymphedema
451
Lymph description
Lipid rich, protein rich fluid
452
CHF will cause what change to lungs?
Decrease compliance of lungs
453
Normal markers of osmolality in the nephron
300mOsm/L
454
Arsenic poisoning antidote?
Dimercaprol
455
Severe otitis externa in immunocompromised patients
Pseudomonas, produces exotoxin A that inhibits EF2 and kills host cells
456
Pregnancy UTI drugs?
Erythromycin
457
Serum sample from the patient fails to fluorescence after incubation with dihydrorhodamine
Chronic granulomatous disease
458
What are patients with CGD most prone to?
Catalase positive organism infections
- inclusive of S aureus, serratia, nocardia, aspergillus, B. Cepacia
459
What does 21 hydroxylase do?
Convert progesterone to aldosterone and convert progesterone to cortisol
460
What does 17 hydroxyprogesterone elevation indicates?
Intermediate to testosterone converting pathway, so indicate that there is congenital adrenal hyperplasia
461
After overdosing this drug, patient presents with hyperglycemia and hypokalemia
Theophylline
462
Gingivitis followed by cough productive of blood tinged sputum with yellow granules?
Actonomycosis, treat with pen G
463
What cells are responsible for COPD symptoms?
Neutrophils
464
Ovarian torsion is most affected by which ligament?
Suspensory ligament, also known as infundibulopelvic ligament
465
Mitotically active endothelial cells with small calibre vessel lumina that contain RBC
Congenital strawberry hemangiomas
466
High riding prostate means?
Posterior urethra tearing
467
Fever, chills, limping, increased ESR in children
Osteomyelitis, most common site of lesion is proximal metaphysis of femur
468
C difficile must be sterilised by?
Chlorine
469
Direct inhibition of gastric acid secretion?
Omeprazole - proton pump inhibitor
470
Long thoracic nerve arises from?
C5-C7
471
Lytic skull lesions, skin rash, recurrent otitis media, S-100 positive, eosinophilic granuloma
Langerhans cell histiocytosis
472
Virulence factor of a gram negative, oxidase negative rods that form greenish colonies on eosin-methylene blue agar
Fimbriae (UPEC)
473
Small testes and inflammatory papular eruptions of face, back and chest (steroid acne), and hypertension
Anabolic steroid use
474
Meningitis antibiotics
Ceftriaxone, ampicillin, vancomycin
475
KNCQ1 gene mutation
Jervell and Lange-Nielsen syndrome - cause of arrhythmias (prolonged QT interval) and sensorineural deafness
476
Spinal bifida caused by?
Failure of fusion of vertebral arches
477
Liver cyst formation after working with animals
Echinococcus granulosus
478
Elevated leukocytes with basophilic granules are
Mast cells
479
KIT mutation, pruritis, flushing, gastric acid secretion?
Systemic mastocytosis
480
Fat malabsorption and RBCs with irregular spiny projections of varying size?
Abetalipoproteinemia, which can also give rise to post-prandial lipid laden enterocytes
481
Alzheimer’s disease neurofibrillary tangles are made of?
Hyperphosphorylated tau
482
Some priapism causing drugs?
Sildenafil, trazodone, fluoxetine, risperidone, prazosin
483
HIV infection and ring enhancing lesions
Does he take TMP-SMX? If yes, then most likely primary cerebral lymphoma, if not, then most likely cerebral toxoplasmosis
Is he EBV positive? If yes, then primary cerebral lymphoma, if not then toxoplasmosis
484
Hx of Crohn’s and now presenting with bone lesions + decreased vibration sensation
Osteomalacia due to Vit D absorption problem
485
Drug that has in-vitro activity against HIV and HBV
Foscarnet - usually used when ganciclovir fails
486
PCOS pathophysiology
Insulin resistance -> increases insulin, which increases androgen (further increased by sex hormone-binding globulin), which increases LH and causes disruption in ovulation
487
Esophageal candidiasis most appropriate Tx?
Fluconazole, which prevents ergosterol synthesis
488
RAI treatment efficacy depends on?
Transmembrane carrier (sodium/iodine symporter)
489
Femoral hernia strangulation is caused by impingement between?
femoral vein and lacunar ligament
490
Ventricle pathways
Lateral -> foramen of monro (interventricular foramen) -> third -> cerebral aqueduct -> fourth
491
What is the difference between PAH and inulin
PAH - filtration and secretion, but no reabsorption
Inulin - filtration ONLY
(Filtration is proportional to plasma concentration, secretion is proportional to transporter saturation)
492
Type I and II error difference?
Type I - false negative
Type II - false positive
493
What helps to maintain temperature when hypothermic?
Shivering
494
Lysed bacteria to living bacteria gene process
Transformation
495
Rhabtidiform larvae and eosinophilia, travel Hx to SEA?
Strongyloides stercoralis, could cause perianal serpiginous rash
496
Down syndrome lab test
Beta-hCG and inhibin A elevated, AFP and estriol decreased
497
Microcytic anemia with parasitic eggs
Necator americanus
498
Biphosphonate side effect
Erosive esophagitis, esophageal cancer
499
Sweet smelling odour in wound, aerobic gram neg rod
Pseudomonas aeruginosa
500
Gout causing HLD drug
Niacin; inhibits hepatic VLDL synthesis
501
Metronidazole MOA?
Creation of free radical within bacteria
502
Pitting edema + prominent rugae of fundus
Menetrier disease - proliferation of gastric mucus producing cells
503
Basophilic stippling in young child with abdominal pain and developmental delay
Lead poisoning
504
Lead poisoning enzyme issue
ALAD, so conversion from ALA to porphobilinogen is reduced
505
MAHA, thrombocytopenia, renal failure, fever, neurological Sx
TTP
506
Depression patient with anorexia
Mirtazapine (alpha-2 adrenergic receptor antagonist)
507
H pylori lives in?
Gastric antrum
508
Spindle shaped endothelial cell and lymphocytes infiltration in HIV patients with pinkish brown papules
Kaposi sarcoma
509
A lot of jumping will cause pain to?
Patellar ligament
510
Which viruses get their envelope from nucleus membrane of host cells?
Herpes viruses
511
COVID-19 virus binds to
ACE2 membrane protein
512
Papule on finger or toes that is painful when cold
Glomus tumour, proliferation of smooth muscle cells
513
Reactive arthritis Sx
Arthritis, urethritis, uveitis - most common trigger is being HLA-B27 genotype
514
Hepatitis contracted with blood transfusion
Hepatitis C - lacks proofreading ability so will mutate
515
Allergic interstitial nephritis Sx
Sterile pyuria, eosinophiluria, interstitial T cell and monocyte infiltration
516
Antibiotic that causes teeth discolouration in babies
Tetracycline
517
Vestibular schwannoma histology
Hypercellular area of spindle cells, hypocellular area of myxoid stroma
518
Mutation in FOXP3 gene
IPEX syndrome (immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome)
- eczema, enteropathy, T1DM, autoimmune thyroid disease
519
Crossover of chromosomes happens at
Prophase I
520
Wobble hypothesis describes what property of genetic code?
Degeneracy
521
Peau d orange pathophysiology
tumour invade the lymph vessels, block lymph flow, tissue will swell but connective tissue will be pulled back
522
Ascaris lumbricoides Sx and Tx?
Dry cough and diarrhoea with weight loss, travel Hx to SEA, Tx with albendazole
523
What cofactor is required to convert DOPA to dopamine?
B6
524
Acute liver failure due to panadol : explain the metabolites
Overdose will cause a buildup of NAPQI, and is treated by giving N-acetylcysteine
525
Why is ampicillin and gentamicin given together?
Ampicillin will help to increase the intracellular uptake of gentamicin
526
Chronic bronchitis will result in
Increased serum hematocrit
527
Protein that carries hormones from paraventricular nucleus and supraoptic nucleus?
Neurophysins, carry oxytocin and ADH
528
Patient migrate from nigeria, ocular disease and pruritic papular dermatitis with secondary changes to skin due to itching
Onchocerciasis
529
What bacteria does not have a cell wall?
Ureaplasma urealyticum
530
C difficile Tx?
Fidaxomicin for non-severe cases - acts by inhibiting sigma subunit of RNA polymerase
Vancomycin
Metronidazole (second line)
531
X linked agammaglobinemia
Mutation in tyrosine kinase gene - respi and GI infection in young child with B cell deficiency
532
TSST is caused by?
Polyclonal T cell activation
533
Internal rotation of arm
Subscapularis
534
Idarucizumab
Reversal of dabigatran
535
Why does curling ulcer form in burn patients
They have reduced gastric blood flow
536
No change in any tumour markers but there is a testicular mass
Teratoma
537
Why is there a stronger hypolipidemic effect by using statin and cholestyramine together than separately?
Using cholestyramine and statin together increases LDL receptor expression
538
Unilateral lower limb swelling and ulceration, together with Hx of DVT
Postthrombotic syndrome
539
MAC and blood gas partition coefficient
MAC is inversely proportional to potency
Blood gas partition coefficient is directly proportional to solubility in blood, inversely proportional to lipid solubility
540
Which structures release glucose to blood after 24 hours of starving?
Liver and renal cortex
541
How do you differentiate beta thalassemia and sickle cell disease?
Sickle cell disease will lead to bone pain and vaso-occlusive crisis, whereas thalassemia will not
542
OCP MOA
Extra estrogen and progesterone, so negative feedback to GnRH, which will prevent secretion of LH and prevent ovulation
543
What does the HIV patient presentation with at early stages of HIV?
Kaposi sarcoma, only when CD4 <200 will there be esophageal candidiasis and cerebral toxoplasmosis, primary CNS lymphoma, CMV etc.
544
What accounts for the difference between minute ventilation and alveolar ventilation?
Physiological dead space
545
Shunt vs dead space
Shunt is where there is blood flow but there is poor ventilation, dead space is there is ventilation but no perfusion
546
Cortisol increases production of which fight or flight hormone
Epinephrine
547
Vertical transmission of HBV will result in mostly chronic hepatitis B as?
Newborns lack cytotoxic T cells that mediate hepatocyte damage
548
Lower limb pain with sudden increase in activity
Medial tibial stress syndrome
549
Superior orbital fissure contains which nerves?
CNIII, CNIV, CNV1, CNVI
- lead to absent corneal reflex
550
HIV patient with low CD4 count pneumonia causative agent?
Pneumocystis jirovecii, on silver staining will give disc shsaped cysts
551
Violaceous rash on eyelid, erythematous papule on hands, muscle weakness
Dermatomyositis - increase risk of malignancy like cervix, lungs, ovarian and bladder adenocarcinoma
552
Sinus and crescent shaped glomeruli
Pauci immune (granulomatosis with polyangiitis) - no deposits
553
Texas, painless wound that is reddening and blistering, lesion turns blue with blackish discolouration at the centre. Causative organism?
Brown recluse spider
554
Aspirin toxicity findings
Respi alkalosis (initially), which progresses to high anion gap metabolic acidosis
555
Anti-Yo antibodies are associated with?
Breast carcinoma (most common), ovary, endometrium and fallopian tube carcinoma
556
Injury here will lead to laxity of knee joint when knee is flexed, laxity when abduction is applied?
Medial collateral ligament
557
Difference between disruption, malformation and deformation
Disruption - breakdown of normal fetal tissue
Deformation - external force causing failure to develop
Malformation - intrinsic toxin causing failure to develop
558
Ethambutol MOA?
Causes impaired synthesis of cell wall polysaccharides
559
Alcohols are effective in what type of viruses?
Enveloped viruses - HSV etc.
560
Alzheimer’s is associated with decreased production of?
ACh
561
Adenosine side effects
Chest pain as it causes transient AV block by increasing potassium efflux from cells
562
Physiologic stress like surgery or exercise causing transient rise in unconj bilirubin
Gilbert’s syndrome - impaired bilirubin conjugation as decreased UDP-glucuronosyltransferase
**more severe Gilbert syndrome - Crigler Najjar syndrome
