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Flashcards in RANDOM BOARD REVIEW Deck (2245):
1

CD55, CD59 should make you think of this particular blood d/o. What are the triad that this d/o commonly presents with?

Paroxysmal Nocturnal hemoglobinuria (PNH)

ø CD55/CD59 prevents complement from inactivating -> complement stays activated -> hemolysis

hemolytic anemia

hypercoagulable state (thrombosis on imaging)

decreased blood counts (leukopenia + thrombocytopenia)

2

location of carnitine acyltransferase II

inner-mitochondrial matrix

3

patient w/ thyroid w/ mixed, cellular infiltration w/ multi-nucleated giant cells

sub-acute thyroiditis "de Quervain's thyroiditis" aka granulomatous thyroiditis - usually due to viral infection of the thyroid; starts off w/ brief thyrotoxic phase followed by transient hypothyroidism.

Painful, tender thyroid

4

cola-colored urine following a URI + renal biopsy of the mesangium showing darkened areas of deposits

cola-colored urine following a skin infection + renal biopsy that shows granular deposits in the mesangium + BM 

Q image thumb

IgA nephropathy "Berger's disease"  (deposits = IgA)

Post-strep glomerulonephritis (deposits = IgG, IgM, C3)

5

bug that can cause achalasia, megacolon, and megaureter, and enlarged cardiac apex

chaaaaaaagas disease (american trypanosomiasis)

endemic in rural areas of centra/south america

6

how do you think these variables will change in a patient with lactase deficiency:

stool osmotic gap

stool pH

breath H content

  • stool osmotic gap - increase due to presence of poorly absorbable contents in the colon
  • pH - decrease because more lactose is delievered to the colon where it is fermented by bacteria to produce SCFA + excess H+
  • breath H content - increase

7

3yo M presents with arm held close to the body w/ elbow extended and forearm pronated; is in minimal distress until attempts are made to move the elbow. No other problems are noted

What happened to get the child in this?

how to reduce this?

radial head subluxation "nursemaid's elbow" 

occurs when there is a sharp pull on the hand while the forearm is pronated and the elbow extended, which causes the annular ligament to slip over the head of the radius and slide into the radiohumeral joint, where it becomes trapped

reduce: fully supinating the arm, followed by full flexion of the elbow

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8

how do these factors change with Glanzmann thrombasthenia

Platelet Count

Bleeding time

PT

PTT

ristocetin response

Platelet Count = NC

Bleeding time = increase

PT = NC

PTT = NC

ristocetin = normal

9

common sx of TTP/HUS in adults vs kids

trmt?

pentad: neurologic ∆'s, renal failure, fever, thrombocytopenia, and microantiopathic hemolytic anemia 

adults: mostly neurological ∆s

kids: mostly renal ∆s

trmt: plasmapheresis

10

Patient comes in complaining of a sensory deficit (green). What is the nerve injury and accompanying motor deficits? What is usually the cause of injury?

Q image thumb

Femoral n. (L2-L4)

∆ thigh flexion, leg extension (ie difficulty w/ stairs, frequent falling due to knees buckeling, diminished patellar reflex)

usually due to mass (hematoma) involving iliopsoas or iliacus muscles, since the femoral n. travels through the psoas major m. and emerges laterally btwn the psoas and iliacus m. and runs down the inguinal ligament into the thigh

11

patient comes in with this has what d/o? how do yout ell?

inheritance pattern of this d/o?

Q image thumb

NF-1

  • cutaneous neurofibromas - fleshy, dome-shaped, pedunculated
  • cafe-au lait spots (hyperpigmention)

AD

12

Medial malleolus

what runs anterior to it? posterior to it?

anterior: saphenous n. + great saphenous v

posterior: posterior tibial a., tibial n., flexor digitorum longus, flexor hallucis longus, tibialis posterior

13

buzzword: polymyalgia rheumatica

Temporal arteritis (increased ESR)

14

∆ btwn sampling and selection bias?

  • sampling bias = type of selection bias that occurs due to non-random sampling of a target population
  • selection bias (attrition bias) = loss to follow-up; usually a problem in prospective studies because 

15

absence seizure

description (post-ictal state)?

first line treatment?

brief episodes of staring, ø post-ictal confusion

ethosuximide

valproate

16

diagnosis?

Q image thumb

Malassezia furfur - spaghetti and meatballs appearance on LM

17

tetralogy of fallot

caused by abnormal development of?

what determines the severity of symptoms?

how do these patients usually present?

neural crest cell migration through the primitive truncus arteriosus and bulbus cordis

degree of RV outflow tract obstruction (pulmonic stenosis) - the more severe it is, the more blood will flow from RV -> LV across the VSD and cause cyanosis

infants: cyanosis that worsens w/ feeding, crying, or exercis

older children: squatting to improve pulmonary blood flow

18

how do these factors change with TTP-HUS d/o?

Platelet Count

Bleeding time

PT

PTT

plasma fibrinogen levels

smear

Platelet Count = decrease

Bleeding time = increase

PT = NC

PTT = NC

plasma fibrinogen levels = normal

smear = RBC fragmentation

19

unilocular cystic mass w/ clear fluid in ovaries; cyst wall covered w/ papillary outgrowths

dx?

serous cystadenocarcinoma - thin-walled, lined with fallopian-like epithelium

20

what is the lecithin-sphingomyelin ratio indicative of?

when and why does this ratio increase?

fetal lung maturity

note that lecithin is also known as phosphatidylcholine

>1.9 = indicative of mature fetal lungs, usually at ~32-32wks gestation; Lecithin increases sharply while sphingomyelin is unchanged; increases are due to cortisol

(due to ACTH/CRH from fetal pituitary and placenta; CRH secretion from the placenta is also upregulated by cortisol)

21

ectopic pregnancies are generally treated with...

MTX - folate antagonist that ultimately inhibits trophoblast division

22

muscle rigidity is observed in experimental animal with chemically destroyed dopaminergic neruons of the substantia nigra, but the rigidity fails to improve w/ continuous dopamine infusion. Why?

BBB (tight junctions = zonula occludens), duh

23

"ballooning degeneration" is indicative of

acute viral hepatitis

24

reducing substance in urine that is not glucose

fructose - fructokinase deficiency (AR, benign, asymptomatic condition)

25

HTN Rx to avoid if you're also hypoparathyroid

loop diuretics bc they decrease blood Ca levels.

26

what exits the formaen ovale

v3 - provides sensory + motor innervation to muscles of mastication and the muscles that open the jaw

27

what is a compression lesion that can result in 3rd nerve palsy?

what is an ischemic process that can also result in 3rd nerve palsy?

compression: aneurysm of R posterior cerebral artery (remember that it courses between this and the superior cerebellar arteries as it leaves the midbrain)

ischemic: diabetes

afftects ipsilateral eye

28

HBV antigen that correlates w/ viral replication

HBcAg, HBeAg

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29

of these, which one is resistant to outliers?

mean

mode

standard deviation

variance

range

mode

30

how do you calculate GFR?

 

calculated using creatinine or inulin clearance, or the Starling equation

Clearance = (Urine Conc * Urine Flow Rate ) / plasma conc.

31

patient suspected of malaria has enlarged erythrocytes containing punctate granulations + oval bodies. Which malaria subtype?

plasmodium vivax or ovale

32

newborn with scrotal sac w/o palpable testes, enlarged phallus w/o the normal appearance of a penis. Urogenital sinus is present. CT shows 2 normal sized ovaries. Karytotype is 46 + barr body

21 - hydroxylase deficiency -> ø cortisol, ø aldosterone, but increased androgen production (which control the external genital differentiation) -> F fetus will be masculinized (ie labial fusion, phallic enlargement, urogenital sinus)

karyotype = genetically F (barr body = inactivated X chromosome, which only happens in females)

ø SRY = Mullerian develops into uterus, fallopian tubes, ovaries 

33

pathogenicity of H influenza

anti-phagocytic capsule

 Type B is most invasive - made w/ polyribitol phosphate

34

Which one does this graph represent? (choose one)

Aortic insufficiency

Aortic Stenosis

Mitral Stenosis

Mitral regurgitation

Q image thumb

mitral regurgitation

35

Eaton Lambert Syndrome is a paraneoplastic syndrome of....

small cell carcinoma of the lung

forms autoantibodies that react w/ PRE-synaptic Ca channels and hamper the release of ACh

36

nerve that passes the lateral epicondyle of the humerus? medial epicondyle?

lateral: radial

medial: ulnar

37

baby w/ subdural hematoma + bilateral retinal hemorrahages

shaken baby syndrome - results in tearing of bridging veins -> subdural hematoma

38

if angle btwn SMA and aorta is decreased, what structures are going to be obstructed by the artery?

transverse portion of duodenum -> partial intestinal obstruction

39

oxaloacete reacts with glutamate to form aspartatey. What cofactor is required?

B6 - pyridoxine - cofactor for transamination + decarboxylation of a.a., gluconeogenesis

transamination rxns occur btwn amino acid and a-ketoacid: the amino group is transferred from the a.a to the a-ketoacid, which becomes an a.a.

key to this question is to know that oxaloacetate (a-ketoacid) reacts w/ glutamate (a.a.) --> aspartate (resulting a.a.) + a-ketoglutarate (resulting a-ketoacid)

40

dx + complication?

Q image thumb

bicornuate uterus

  • congenital malformation taht results in an abnormal Y shaped uterine cavity
  • complication: recurrent spontaneous abortions, esp. in the 2nd trimester, because it results in defective placental implantation

41

patients with allergic bronchopulmonary aspergillosis (ABPA) have very high serum levels of what?

serum IgE

eosinophilia

IgE + IgG antibodies against aspergillus

causes intense airway inflammations + mucus pluggings w/ remission + exacerbations; repeated exacerbations -> transient pulmonary infiltrates + proximal bronchiectasis 

42

34M, tall/slender w/ disproportionately long arms and legs has flesh colored nodules on lips and tongue. underwent tyroidectomy a few years ago.

dx?

MEN2B - marfanoid habitus + mucosal neuromas + thyroidectomy (suggests hx of MTC)

43

17yo girl is troubled by her sexual dreams and tells her friends that she is going to become a nun. 

Reaction formation - unconscious adoption of behavior opposite to that which owuld reflect true feelings and intentions

44

How does the etiology of hepatic absesses differ between developed countries vs developing countries?

developed countries - 2˚ to bacterial infection (S. aureus) 

developing countries - 2˚ to parasitic infection (amebic or echinococcal)

45

demeclocycline

ADH antagonist

46

to make the diagnosis of hirschsprung's disease, where should you sample?

mucosa or submucosa or muscular layer

dilated or narrow part

submucosa of the narrow part - the disease is due to failure of the neural crest cells to migrate into the bowel and develop into the ganglion cells of the submucosal (meissner) and myenteric (auerbach) plexus of the bowel wall

47

patient w/ thyroid that extends into the surrounding structures; hard and fixed

reidel's thyroiditis w/ (+) anti-thyroid peroxidase antibody titers; hard and fixed gland can simulate a malignancy

48

infant w/ persistant jaundice, muscle rigidity, lethargy and seizures and kernicterus

dx?

trmt?

Crigler-Najjar

∆UGT = no bilirubin conjugation = elevated unconjugated hyperbilirubinemia

patients have kernicterus (bilirubin deposition in brain)

trmt: phototherapy + plasmapheresis

 

49

why would you treat Crigler-Najjar - type II patients with phenobarbital?

phenobarbital increases hepatic enzyme synthesis, and may increase UDP-GT in patients with Crigler-Najjar

50

patient w/ enlarged ventricles only has a problem w/ what type of cells?

arachnoid granulations (resorbs CSF into the venous sinuses)

51

when is pulmonary vascular resistance the LOWEST?

at FRC, which occurs at the end of an expiration during normal tidal volume change

incr. lung volume -> incr PVR due to longitudinal stretching of alveolar capillaries

decr. lung volume -> incr PVR due to decreased radial traction from adjacent tissues onto the large extra-alveolar vessels

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52

patients w/ non-coronary atherosclerotic disease are most likely to die from what disease?

how about diabetes?

how about chronic kidney disease

cardiovascular mortality, stroke, MI

53

How do you determine RBF? RPF?

RPF = PAH clearance = (urine PAH * urine flow rate) / plasma PAH

RBF = PAH clearance / (1-Hct)

54

how does N. Meningitidis infection occur

pharyngeal colonization - adheres + penetrates mucosal epithelium into the blood

55

fibrous intimal thickening w/ endocardial plaques limited to the R heart 

what correlates with disease severity?

carcinoid heart dz associated with carcinoid syndrome

degree of endocardial fibrosis is correlated w/ 

- plasma levels of serotonin + urinary 5-OH-indoleacetic acid (serotonin metabolite)

56

defective ossicles causes what type of hearing loss

condutive

57

cell involved in clearing the infection in a patient with PID 

Th1 cells - if it's not mentioned, assume gonococci or chlamydia.

In the US - chlamydia is the most common bacterial STD; intracellular pathogens -> elicit Th1 lymphocyte response

58

how does small cell carcinoma compare to squamous cell carcinoma of the lung compare in terms of the paraneoplastic symptoms?

small cell - ACTH + vasopressin + Lambert Eaton Syndrome

squamous cell - PTHrP

59

CMV treatment?

CMV treatment in HIV patients?

gangciclovir - guanine nucleoside analog

foscarnet - may cause nephrotoxicity, electrolyte ∆s (hypo-Mg, Ca, K)

60

status epilepticus

treatment to stop the seizures? 

Rx to prevent recurrence of seizures?

if patient continues to seize?

  • 1st line treatment: Benzodiazepines (lorazepam) - binds GABAA channels and increases Cl conductance, thereby stabilizing the membrane from further depolarization
  • Prevention: Phenytoin - reduces ability of Na channels to recover from inactivation
  • continues to seize: phenobarbital - same MoA as benzo

61

immunocompetent hosts infected w/ coccidiodes immitis can present with?

what about immunocompromised hosts?

immunocompetent: acute pneumonia + erythema nodosum

immunocompromised: chronic progressive pneumonia, pulmonary nodules, meningitis, erythema nodosum

62

patient w/ small bowel bx w/ nests of mast cells within mucosa, pruritus, rash, flushing, and abd cramps most likely also has ...

gastric hypersecretion

why? mast cells release histamine -> parietal cell production of HCl

this person has systemic mastocytosis - where mast cell proliferation occurs in the bone marow and other organs

63

MoA for Rx used to treat acute asthma excerbations

ß2 (Gs) agonist - results in increased cAMP in smooth mucle cells -> bronchial smooth muscle relaxation

64

IL4 function

stimulates growth of B cells and increases # of Th2 cells to site of inflammation (produced by Th2 cells)

65

F w/ small mobile mass taht changes in size with her menstrual cycle should make you think of this breast tumor



 

Fibroadenoma

  • Small, mobile firm mass, usually in stroma
  • ∆s with menstrual cycle, pregnancy (due to ∆'s in estrogen)
  • not a precursor to breast Ca

 

 

66

MEN 1

gene mutation?

what does it affect?

MEN1 gene mutation

pituitary gland, parathyroid gland, pancreas (the 3 "P"s)

(presents w/ kidney stones + stomach ulcers)

A image thumb
67

sleeping agent that has less potential for tolerance and addiction compared to other medications

Zolpidem - binds to GABAA receptor and enhances the inhibitory action of GABA in the CNS

less risk of potential compared to other sleeping agents (ie Benzodiazepines such as Temazepam and estazolam) since it has a shorter half-life than these. 

68

eye field looks like this:

where is the lesion?

Q image thumb

R optic tract or optic radiation

E

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69

Enteracept MoA

"decoy receptor" - TNFa-receptor molecule linked to the Fc component of IgG1, thereby sequestering TNFa w/ subsequent removal 

note: get PPD before initiating therapy to determine if there is latent TB

70

what is the Hawthorne effect?

tendency of study population to affect an outcome (ie change their behavior) due to the knowledge of being studied

think of hawthorne as a  "hawk" that is watching their prey (study population); obviously if the prey knows thier being watched by their predator, they will modify their behavior to avoid getting caught

71

26yoM w/ single genital ulcer that is indurated and painless. What should you treat him with? What is the MoA of this Rx?

Patient likely has syphillis (Treponema pallidum); treat w/ Penicillin G

MoA: structural analog of D-Ala-D-Ala, thereby inhibiting transpeptidase, which normally cross-links peptidoglycan cell wall formation. Weakened cell wall integrity = osmotic lysis of bacterium

72

pupillary light reflex involves which 2 nerves?

afferent: CN 2

efferent CN 3

73

S. bovis endocarditis is associated with?

GI lesions (Colon cancer)

74

increase HR and CO w/ a normal PaO2 + PaCO2 

exercising

not to confuse w/ panic attacks, which usually has increase RR --> respiratory alkalosis

75

why is making an anti-gonococcal vaccine using the pilus component likely to fail?

 

b/c the pilus is known to undergo antigenic variation at high frequency

76

what's going on here?

Q image thumb

blood transfusion

increased MSFP and decreased resistance to VR  (extra blood distends the BV)

77

pt w. signs of CHF on aspirin and hctz should also add what to his regimen

hx is signficant for HTN and MI 2 years ago

  • ß blockres, esp. carvedilol - slows ventricular rate and decreases PVR (afterload) by antagonizing ß1, ß2, and alpha1 receptors
  • ACEi/ARB - prevents chronic AII-mediated L ventricular hypertrophy and remodeling that occurs in association w/ myocardial failure

78

1yo M w/ severe hypotonia, hepatomeagly, cardiomeagly

deficient enzyme?

Pompe disease - alpha-1,4-glucosidase

79

evidence of acute graft rejection in a cardiac transplant?

usually occurs within 1-4 weeks following transplant

dense infiltrate of T cells (rejection is mediated by host T cells sensitization against graft MHC)

sx: systolic dysfunction (dyspnea on exertion or paroxysmal nocturnal dyspnea)

80

A patient presents to your office after lunch at one of the better restaurants in town. She is complaining of dizziness, flushing, diarrhea, tachycardia, and a severe headache. This started about 30 minutes after she had a grilled tuna fish steak for lunch. A number of other patrons had the fish as well but did not develop symptoms.
The fish tasted fine although a bit peppery for her liking. She has never had an allergic reaction to seafood before.
The most likely diagnosis is:
A) Staphylococcus food poisoning.
B) Bacillus cereus food poisoning.
C) Ciguatera poisoning.
D) Scombroid poisoning.
E) Seafood allergy.
 

C) Ciguatera poisoning

Scombroid poisoning occurs when bacteria in a dark-meat fish produce histidine which is broken down into histamine (ie tuna, mackerel, bluefish, mahimahi, etc.) and the food is improperly handled. Fish may have a metallic or peppery taste. When eaten, patient develops a symptom complex suggestive of histamine effects including: flushing, diarrhea, dizziness, wheezing, tachycardia, and severe HA. An occasional patient will become hypotensive. The symptoms occur 20-30 minutes after ingestion. Self-limited, generally lasting less than 6 hours, but patient respond well to antihistamines such as diphenhydramine.
Patients with ciguatera poisoning present with GI symptoms such as cramping, vomiting, and diarrhea followed by nondermatomal neurologic symptoms such as perioral numbness, burning foot pain, ataxia, weakness, and vertigo. The neurologic symptoms can last for up to 1 year. An almost pathognomonic finding for ciguatera poisoning is hot-cold sensory reversal on the face.

81

complication of subarachnoid hemorrhage

what can the patient be treated with to prevent this?

arterial vasospasms  (occur due to impaired brain autoregulation)

trmt: Nimodipine - selective Ca channel blocker

82

11yoM w/ difficulties with balancing and night vision. Mother complains of foul smelling stools and failure to thrive as an infant.

PE: poor muscle coordination, ataxia, decreased proprioception, and vibratory sense. Labs: decreased cholesterol and vitamin E.

Dx?

∆ MTP (microsomal transfer protein) - transfers TG onto apolipoprotien B as part of VLDL synthesis and affects abosrption of dietary fats, cholesterol, and fat-soluble vitamins

  • inability to generate chyloµ -> fat accumulation in enterocytes -> foamy enterocytes
  • decreased VLDL secretion into blood stream

findings: failure to thrive, steatorrhea, acanthocytosis, ataxia, night blindness, clear foamy macrophages

83

bcr-abl

CML t9;22

84

contraindication for thiazolidinediones (TZD) such as rosiglitazone 

CHF patients

85

main pancreatic duct is derived from what structure?

ventral pancreatic primordium

86

superior vs inferior parathyroid glands originates from:

shares embryological origins with

superior: 4th pouch

inferior: 3rd pouch; shares embryological origins thymus

 

87

patient w/ vitamin C deficiency has gingival bleeding, petechiae, ecchymoses and poor wound healing. Why?  

impaired collagen hydroxylation of proline + lysine residues, which happens in the RER

this process helps collagen attain its maximum tensile strength

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88

discrete subepithelial humps on EM is seen in which renal disease?

post-strep glomerulonephritis (PIGN) - usually occur a few weeks following a skin or pharyngeal infection

89

down syndrome is associated with 

two leukemias 

two GI abnormalities

cardiac defects

ALL, AML

duodenal atresia, Hirschsprung

ASD, VSD (endocardial cushion defects)

90

interpret this

HBsAg negative
anti-HBc positive
anti-HBs positive

Immune due to natural infection

91

c-myc

burkitt's lymphoma t8;14

92

hamartoma definition

growth of a tissue type native to the organ of involvement

93

genes involved adenoma to carcinoma sequence (what structures are typically seen w/ each mutation?

AK53 (with intervening mutations)

  • APC - hyperproliferative epithelium -> small (if you can see the entire polyp on the slide) adenomatous polyp w/ a fibrovascular stalk w/ tubular glands + villous components
  • COX2 
    • ​patients taking aspirin have been shown to have a lower incidence of adenomas compared to the general population 
  • Kras -> unregulated cell proliferation -> large adenomatous polyp 
  • DCC
  • P53 -> disordered/carcinoma

94

Pathophysiology of Zenker's diverticulum

type of diverticula?

cricopharyngeal muscle dysfunction

FALSE diverticulum = contains only mucosa + submucosa layers

95

how do you tell whether a transplant patient is undergoing rejection (acute/chronic) or GVHD?

  • rejection (acute/chronic) - host CTLs activated aganist donor MHC -> rejection of graft
    • findings: acute rejection = vasculitis of graft vessels; chronic rejection = fibrosis of graft stroma + BV 
  • GVHD - graft T cells activated aganist against host MHC -> rejection of host
    • findings: any host organ may be a target of GVHD, but the skin, liver, and GI tract are most severely affected -> desquamating skin rash, bloody diarrhea

96

What does this represent? (choose one)

Increase preload

Increase afterload

Systolic dysfunction

Increased ejection Fraction

Normal Saline Infusion

Q image thumb

Increased afterload

97

Serotonin syndrome (mental status ∆, neuromuscular dysfunction, autonomic instability - rapid/large ∆BP, ∆HR) is treated with....

Cyproheptadine - antihistamine w/ anti-serotonergic properties

98

pt w/ a-fib and hx of pulmonary disease. Of these Rx, what would you give to the patient?

amiodarone

diltiazem

esmolol

lidocaine

procainamide

diltiazem - Ca blocker that inhibits Ca influx into the VSM and myocardium; also has AV nodal blocking effects and is used to control rapid a-fib and a-flutter

  • amiodarone - cases ARDs/pulmonary fibrosis
  • esmolol - selctive ß1 blocker - generally not use in patients w/ poorly controlled pulmonary disease
  • lidocaine - used in MI
  • procainamide - class IA - often used for ventricular arrhythmias

99

maculopapular rash that starts on head and progresses downwards to the extremities

cough, coryza, conjunctivitis, and koplik spots

measles (rubeola)

100

Rust colored urine + facial swelling should make you think of...

what determines prognosis?

PIGN

prognosis determined by AGE!! 

young children = good; most recover completely w/ conservative Tx

adults = not so good; only 50% will resolve completely; rest will develop chronic GN or RPGN

101

what is tertbutaline and what is it used for?

ADR?

ß mimetic tocolytic drug used to delay labor + delivery by suppressing uterine contractions

ADR: increased risk of neonatal intraventricular hemorrhage, hypoglycemia, hypocalcemia, ileus

102

During excitation-contraction coupling, Ca released from the sarcoplasmic reticulum binds to ___________ and causes ___________

troponin C (bound to tropomyosin) 

causes the tropomyosin to shift, thereby exposing the actin binding sites for myosin and allowing contraction to occur

103

"bilateral wedge-shaped bands of necrosis seen over the cerebral convexity that follow the interhemispheric fissure - just a few cm lateral to it"

hx report described in a patient who suffered a massive MI/cardiogenic shock

watershed infarction - necrosis that occurs btwn the zones of perfusion of the MCA, ACA, and PCA

104

why is it that a heavy smoker w/ chronic cough + lower extremity edema + cyanosis + expiratory wheezes faint with supplemental O2? 

prolonged hypercapnia = CO2 doesn't stimulate the respiratory drive in central chemoreceptors (medulla) as it normally does

therefore hypoxia is the only stimulator of respiratory drive; rapid increase in O2 --> respiratory stimulus disappears --> decr. respiration -> confusion + fainting

105

bipolar patient recently started a HTN Rx and develops involuntary movements, ataxia, and tremor. What HTN Rx was she given?

basically anything that increases PCT reabsorption of Na/H2O

Thiazide

ACEi

NSAIDS

(not loop diuretics)

106

in menstruation:

proliferative phase begins with_________ and ends with _________

secretory phase begins with_________ and ends with _________

proliferative phase begins with menstruation  and ends with ovulation

secretory phase begins with ovulation and ends with onset of menses

107

46xx with BP 150/95, serum K 3.2, elevated plasma androgens, and 17OH progesterone, and decreased aldosterone has a mutation in what enzyme

11ß hydroxylase - note the high P and low K - indicates that some Aldo-like factor is being made (ie DOC)

108

hypophysectomy (removal of pituitary gland) induces a decrease in epinephrine  secretion by the adrenal glands. What enzyme is responsible for the observed effect?

in the adrenal medulla, the synthesis of catecholamines begins with conversion of tyrosine -> DOPA via tyrosine hydroxylase

conversion of NE -> Epi occurs via phenylethanolamine-N-methyltransferase (PNMT), which is under the control of cortisol (increases the synthesis of PNMT).

Therefore, ø ACTH = ø Epi

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109

46 XX neonate w/ male external genitalia should make you think of...

androgen excess during gestation; usually due to CAH (21 hydroxylase or 11 hydroxylase deficiency)

110

why are there 2 peaks in isoniazid metabolism?

what other Rx have similar patterns of metabolism?

Q image thumb

2 peaks = 2 distinct groups in the population that suggest a polymorphism in drug metabolizing capacity

isoniazid is metabolized via acetylation, therefore there are

fast acetylators (normals)

slow acetylators (leads ot accumulation of Rx in plasma)

other Rx that show this pattern: dapsone, hydralazine, procainamide

note: slow acetylators have a higher risk of developing drug-induced lupus!!

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111

what 2 disorders specificially cause degeneration of spinocerebellar tracts, dorsal column of the spinal cord, and peripheral nerves

Vitamin E 

Friedreich ataxia

both result in ataxia, dysarthria, and loss of position/vibration sensation

112

how is MCHC affected in patients with hereditary spherocytosis?

elevated MCHC - indicates membrane loss and red cell dehydration (think of these cells going through the spleen and the macrophages taking a bite of the cytoplasm every time, therefore the Hgb concentration increases with every bite removed).  

dx best confirmed with the osmotic fragility test

113

45yo F w/ long history of pruritis and fatigue who developed pale stool and xanthelasma

primary biliary cirrhosis - pruritis is often the first symptoms and may be very severe, esp at night. 

  • hx: destruction of intralobular bile ducts by granulomatous inflammation and infiltrate of macrophages, lymphocytes, plasma cells, eosinophils

114

blastomycosis dermatitidis

where is this endemic to?

dimorphic fungus - cause pulmonary symptoms (cough, sputum production, hemoptysis, dyspnea, and pleuritic chest pain) in immunoCOMPETENT hosts; usually w/ travel Great Lakes, Mississippi, Ohio River basins

forms GRANULOMATOUS inflammation

in immunocompromised hosts, it may lead to disseminated mycosis (fever, lung + skin + bone involvement)

trmt: itraconazole

115

describe all of the MEN and associated organs

1,2,3 --- 3,2,1

Type I has 3 Ps:  Parathyroid, Pancreas, and Pituitary
Type II has 2 Ps: Parathyroid, and Pheochromocytoma
Type III has 1 P: Pheochromocytoma.

116

difference between hypnagogic vs hypnopompic hallucinations?

hypnagogic = occur when patient is falling asleep

hypnopompic = occur when a person is just awakening from sleep; usually with sleep paralysis, cataplexy, and sleep attacks (narcolepsy)

117

metabolic enzyme that is most upregulated when cells switch to anaerobic metabolism  

PFK-1 (first committed step of glycolysis)

why? glycolysis becomes the sole source of ATP via substrate level phosphorylation + phosphoglycerate kinase + pyruvate kinase 

118

anti-arrhythmia agent that causes agranulocytosis, bbone marrow suppression, neutropenia, hypoplastic anemia

procainamide, class IA

119

short stature, hypotonia, obesity, mental retardation

Pradar Willi Syndrome - microdeletion on chr. 15 that is inherited from the father

120

adherent membrane, gram + rod

diphtheria - produces toxins that inactivates eukaryotic elongation factor 2

121

what is metyrapone?

  • agent used to test whether there is an interruption in the HPA feedback loop
  • inhibits 11ß-hydroxylase, which is responsible for the conversion of 11ß-deoxycortisol -> cortisol (resulting in increased pituitary secretion of ACTH, which causes the adrenal glands to produce even more 11ß-deoxycortisol - measurable in the urine as 17-OH-corticosteroids)
    • normal HPA = metyrapone will cause significant increase in 11-deoxycortisol and 17-OH-corticosteroids in urine

122

Patients w/ alcoholic-induced cirrhosis have gynecomastia, palmar erythema, spider angiomata, asterixis, ascites, pedal edema, testicular atrophy, hepatic encephalopathy, and splenomeagly. 

What causes the signs in bold?

 

Hyperestrinism "hyper-estrogenism" is due to:

1) liver cannot metabolize circulating androstenedione (which results in increased estradiol levels)

2) SHBG rises, which results in a higher binding of testosterone, thus decreasing the ratio of free T to E (ie more estrogen)

 

123

64yo M w/ persistent back pain, constipation, easy fatigability, low hemoglobin, and eelvated serum creatinine should make you think of....?

What would a biopsy of the affected organ show?

Multiple myeloma

easy fatigability - due to anemia

constipation - due to hypercalcemia

bone pain - osteoclast activation by myeloma cells

renal failure (zaotemia)

Bx: large eosinophilic casts (bence-jones proteins)

124

ulnar nerve (C8-T1) is commonly injured at which location?

passes in "Guyon's Canal" (btwn hook of hamate and pisiform bone) 

medial epicondyle of humerous "funny bone"

125

pt with recurrent URI (susceptible to strep. pneumonia and H. influenzae) has a mutation in..

bruton agammaglobulinemia (x-linked recessive)

126

derivative of the common cardinal veins

SVC

127

drug that reduces post-prandial hyperglycemia in diabetics

acarbose - inhibits alpha-glucosidase on intestinal brush border to delay glucose absorption)

(car going through the intestines)

Aspart, Lispro, Gluisine - activates insulin receptors in fat, muscles, and liver

128

spherules should make you think of...

coccidiodes immitis

thick-walled spherules filled w/ endospores

common in southwestern states (desert area, mold form is present in soil

pulmonary form: flu-like illness, cough, erythema nodosum

disseminated form can affect skin, bone, and lungs

129

name this please

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cryptococcus

130

only partially dsDNA circular virus

HepB 

131

where embryonic hemoglobin synthesis occurs during 1-7 month

liver

(before that will be in the yolk sac) 

(after that will be in the bone marrow)

132

What do you want to treat AML patients with? What is absolutely contraindicated and why?

AML - acute myelogenous leukemia M3 form - treat with ATRA (all trans-retinoic acid) since it stimulates the differentiation of myeloblasts into mature granulocytes and induces remission

DO NOT TREAT WITH CHEMORX - it can induce release of Auer rods and cause DIC

133

how to differentiate between CML + leukemoid reaction

 

leukocyte alkaline phosphatase

CML = LOW (granulocytes are dysfunctional)

leukemoid = HIGH (granulocytes are functional)

134

bromocriptine

dopamine agonist that inhibits prolactin secretion; trmt for prolactinoma

135

macrocondida

histoplasma capsulatum

136

cause of unilateral SVC syndrome (R face + arm swelling and engorgement of subcutaneous veins on the R side of the neck)

obstructed R brachiocephalic vein (drains R internal jugular + R subclavian v. (which drains the R external jugular), usually due to an apical lung tumor, thrombotic occlusion, or prolonged central cathther placement

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137

alkaline phosphatase is a marker of?

osteoBlasts

staining with this enzyme can help identify bone tumors

138

Urinary deoxypyridinoline reflects activity of which cell type?

osteoClasts

note that these cells use carbonic anhydrase to produce H+, which are then pumped from the cytoplasm -> resorptive pit to create the acidic milieu required for bone demineralization

139

common cause of pyelonephritis?

can occur via hematogenous or ascending (more common)

in ascending pyelo - there is vesicoureteral reflux, which brings pathogens present in the bladder up to the ureter. this is common in patients w/ frequent bladder infections, which may weaken the vesicoureteral junction and facilitate reflux

140

gastric ulcer on the lesser curvature can penetrate into which arteries?

L/R gastric (both form gastro, depending on its location

141

decreased exercise tolerance, muscle pain and cramping during exercise + myoglobinuria

blood lactate is very low post exercise

muscle bx: excess glycogen

McArdle - ∆ glycogen phosphorylase

142

what two statistical measures depend on disease prevalence in the population? 

NPV and PPV

NPV = inversely related (lower prevalence = higher NPV)

PPV = directly related (higher PPV = lower NPV)

(sensitivity and specificity of a test do not depend on the prevalence of the disease in the population)

143

how would SV or compliance change in order to increase PP?

increase in SV

decrease in compliance

144

42yo alcoholic has a smear that shows hypersegmented neutrophils. What is he deficient in?

folic acid deficiency

(note that B12 deficiency also shows hypersegmented neutrophils, but folic acid deficiency is common in alcoholics)

145

normal function of progesterone?

what happens if you withdraw progesterone?

function: differentiation of endometrial stromal cells into decidual cells that can accomodate pregnancy 

withdrawal: endometrial cells undego apoptosis -> bleeding

146

where is the sphenoid sinus located?

anterior to the optic chiasm

147

cause of megaloblastic anemia (low Hg and elevated MCV) in an alcoholic

folic acid deficiency -> defect in DNA synthesis (due to ø purine/pyrimidine production) -> megaloblastic RBCs

148

a drug is virtually eliminated after how many half-life intervals?

5

149

What should you monitor continuously in cirrhotic patients who are at risk of developing HCC? 

AFP

150

normal atrial/ventricular pressures on the R vs L side of the heart

max/ min

  • R atria = 10, 0
  • R ventricle = 25, 4
  • Pulmonary artery = 25, 9
  • L atria = 12, 2
  • LV = 130, 9
  • Aorta = 130, 70

151

virulence factor of bacillus anthracis?

what are diagnostic clinical features of this bug? 

what do you treat bacillus anthracis with?

D-glutamate capsule - antiphagocytic

mediastinal widening + black eschar + serpentine/medusa head on microscopy

ciprofloxacin

152

clavulanic acid, sulbactam, and tazobactam can "extend the spectrum" of penicillin-family antibiotics. What does this mean?

allows the the penicillin family of antibiotics to be effective aganist organisms that produce ß-lactamases (ie S. aureus, H. influenza, Bacteriodes, and other GN bacteria)

153

internuclear ophthalmoplegia

cause

common manifestation in what d/o?

demyelination of MLF -> impaired adduction of corresponding eye during lateral gaze (note that bilateral adduction during ocular convergence is spared)  

(MLF connects ipsilateral abducens w/ contralateral medial rectus to allow horizontal conjugate gaze movements)

MULTIPLE SCLEROSIS (or MLF stroke)

154

hammerhead ribozymes

degradation of mutant SOD1 mRNA

155

Werdnig-Hoffman Syndrome

what is another d/o that can present the same way?

aka spinal muscular atrophy

congenital degeneration of anterior horn cells -> LMN lesion

floppy baby w/ marked hypotonia, tongue fasciculations, areflexia, muscle atrophy

other d/o: poliomyelitis

156

korotkoff sounds

first become audible during expiration and subsequently becomes audible during all phases of respiration ∆ greater than 10mmHg = think pulsus paradoxicus (acute cardiac tamponade, constrictive pericarditis, severe obstructive lung dz, restrictive cardiomypathy

157

greatest concentration of H. pylori is found where?

pre-pyloric areas of the gastric antrum 

158

rhomboid crystals w/ weak positive birefringence under polarized light

calcium pyrophosphate

(black arrow indicates the direction of the compensator)

Crystals parallel to the compensator = blue

Crystals perpendicular to the compensator = yellow

(compare to monosodium urate crystals, which are yellow when parallel to the light)

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159

hamartomatous polyps

Peutz-Jegher's syndrome

non-malignant hamartomas in the GI

hyperpigmented mouth, lips, hands, and genitalia

160

brain imaging shows a 9mm cavitary lesion in the brain. what type of infarct is this? what is it usually caused by?

lacunar infarcts (

often due to hypertensive arteriosclerosis of small, penetrating arteries.

161

what accounts for the sx (acute abd. pain + neurological sx) observed in acute intermittent porphyria (AIP)?

 

treatment for these sx?

d-aminolevulinic acid + porphobilinogen

hepatic heme production is used for CYP450; AIP can precipitated by anything that alter levels of CYP450 (ie phenobarbital, griseofulvin, phenytoin, OH, low calorie diet), which result in low heme [ ]'s

As a result ALAS is upregulated and there is increased formation of the two substrates above.

AIP patients have ∆porphobilinogen deaminase, which results in an accumulation of these substrates -> acute abd. pain, port-wine colored urine, neurologic symptoms (anxiety, muscle weakness)

trmt: heme (inhibits ALAS, thereby decreasing production of these substrates)

162

identification

modeling of one's behavior after someone who is perceived to be more powerful (ie parent who was abused as a child becomes an abusive parent)

163

buboes vs chancroid vs chancre

bugs that cause them?

what do they look/feel like?

buboes = chlamydia trachomatis (swollen, painful inguinal nodes that coalesce, ulcerate, and rupture)

chancroid = haemophilus ducreyi (tender red papules)

chancre = treponema pallidum (painless lesion)

164

Meningioma

Location

Appearance

Prognosis, presentation

Brain surface (extraaxial attached to dura)

Spindle cells in whorled pattern w/ psammoma bodies, well circumscribed

Adults, Benign; seizures or focal deficits

 

165

What does this represent? (choose one)

Increase preload

Increase afterload

Systolic dysfunction

Increased ejection Fraction

Normal Saline Infusion

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Systolic Dysfunction

166

Pregnancy and the usage of OCs predispose to gallstone formation. How?

  • Estrogen - increases cholesterol synthesis by upregulating HMG-CoA activity, which causes bile to become supersaturated with cholesterol
  • Progesterone - reduces bile acid secretion and slowing gall bladder emptying (hypomotile)

167

phenytoin

MoA

ADR

MoA: inhibits electrical activity in the brain by blocking VG Na channels in neurons, thus increasing the refractory period

ADR:

  • gingival hyperplasia (via increasing PDGF)
  • megaloblastic anemia (interferes w/ folic acid metabolism)
  • ataxia and nystagmus (affects cerebellum+vestibular system)
  • induces CYP450 cytochrome oxidase
  • fetal hydantoin syndrome
  • pseudolymphoma (generalized lymphadenopathy)

168

what is the common ground between sildenafil and ANP?

sildenafil - inhibits cGMP phosphodiesterase -> increase cGMP

ANP - increases cGMP via a second messenger system 

(NO also has the same MoA as ANP)

169

ADR of TMP-SMX

TMP = Treats Marrow Poorly

Megaloblastic anemia (folate antagonist), leukopenia, granulocytopenia

Steven-Johnson Syndrome, Toxic Epidermal Necrolysis

170

causes of 1˚ hemolytic anemia

defect in glycolysis or hexose monophosphate shunt (PPP) - pyruvate kinase (due to G6PD)

171

urine measurement of this would allow diabetic nephropathy to be detected at its earliest stage.

albumin - screen for microalbuminuria

(30-300mg/day in a 24h collection or 30-300protein/mg of creatinine in a spot collection)

172

MoA of CRH in the H-P axis

stimulate release of ACTH, MSH, ß endorphin

173

diuretics that cause ototoxicity

furosemide

174

L homonymous hemianopia w/ macular sparing

R primary visual cortex - occipital lobe - usually due to occlusion of posterior cerebral artery. macula spared due to collateral flow from MCA

175

fructose intolerance

∆ aldolase --> hypoglycemia

176

patient on NTG cannot be on these Rx and why?

sildenafil - both cause incr. cGMP --> extreme vasodilation

177

fever and ulcers on the tongue and oral mucosa + maculopapular and/or vesicular rash on the palms and soles

HFMD - coxsackie type A

178

sandpaper-like erythematous rash (blanches w/ pressure) that begins on the neck, armpits, and groin, and then generalizes

fever + sore throat (gray-white tonsillar exudates) + bright red tongue

s. pyogenes (scarlet fever)

may result in rheumatic fever + glomerulonephritis later on

179

immediate treatment for patients in adrenal crisis (hypotensive, tachycardia, hypoglycemic, vomiting, abd pain, weight loss, hyperpigmentation)

steroids

adrenal glands normally respond to stress by secreting large quantities of glucocorticoids to that is essential to cardivascular and metabolic adaptations during stress

180

gp120 and gp41

function?

what can you use to block their functions with?

env proteins of HIV - viral envelope

gp120 = mediates attachment via CD5 + CCR5 (or CXCR4); block w/ maraviroc 

gp41 = mediates fusion; block w/ enfuvirtide 
"FOURSION; enFOURvirtide"

181

6mo F w/ crying, sweating, shaking chills 1 hr after eating apple-sauce and pureed pears

Deficient enzyme?

Fructose intolerance - ∆ frustose-1-phosphate aldolase

182

how does TLC, RV, FRC, elastic recoil, FEV1/FVC ratio affected in COPD

increased TLC, RV, FRC

decreased elastic recoil, FEV1/FVC

183

external stimulus applied to cells increases the activity of several enzymes, including DHFR and DNA polymerase. What immediately precedes the observed effect?

Rb protein phosphorylation by cyclin kinases (CDK 4, 6) = thereby inactivating it and allowing G1->S transition to occur.

184

42 F complains about episodic spinning sensation associated w/ nausea, ringing on L ear, and always having to use R ear when talking on the phone. 

Meniere's disease - increased endolymph (due to defective resorption) causes damage to vestibular + chochlear components of inner ear

-> triad of tinniitus, vertigo, and sensorineural hearing loss

185

patient w/ sx of dysphagia and chest pain

what would you do if a patient came in complaining of these sx?

 

diffuse esophogeal spasms = intermittent dysphagia and occasional chest pain - may mimic angina pectoris and thereoore it is important to get a cardiac workup to r/o a cardiac cause of chest pai

186

6yo living in old house is irritable, constipated, and has anemia. He has high blood levels of delta-aminolevulinic acid, which is maintained secondary to the presence of which cofactor?

b6 - pyridoxal phosphate

187

splinter hemorrhages on subungual areas

 

janeway lesions - small, nontender, lesions that can appear on the soles of the feet, palms of hthe hands - sign of microembolism

likely due to bacterial endocarditis, where vegetations on the cardiac valves are the source of microemboli

188

when is Ig therapy useful for herpes infections?

immunocompromised hosts, neonates whose mother developed a perinatal varicella infection, or prophylaxis in pregnant females exposed to varicella

189

diagnose this patient: 

recurrent epistaxis, ecchymoses

marked thrombocytopenia

normal Hgb, leukocyte count, and differential

normal fibrinogen levels and PT/INR

no hepatosplenomeagly

immune thrombocytopenic purpura - acquired d/o where there is immune destruction of platelets via anti-platelet antibodies.

190

major stimulator of RR in normal folks

PaCO2 is the major stimulator of respiration (input from central + peripheral chemoreceptors + airway mechanoreceptors)

191

Which one corresponds to this graph?

Acute GI bleed

Pyschogenic polydipsia

Diabetes insipidus

Hypertonic saline infusion

Q image thumb

Hypertonic saline infusion - leads to hypertonic volume expansion (both volume + osmolarity of ECF are increased); high osmolarity of ECF causes water to shift from ICF into ECF, further increasing extracellular volume

net: decreased ICF, increased ECV

192

virluence factor of e. coli that causes UTIs

p. fimbrae - allows adhesion of e. coli to the uroepithelium

193

patient w/ DIC

if you could only order 3, which labs should you order

Platelet count

fibrinogen levels

FDP

194

ultrastructural change that would most likely indicate irreversible myocardial cell injury?

appearance of vacuolization or amorphous densities in the mitochondria = implies permanent inability to generate ATP via oxidative-phosphorylation

(note: mitochondrial swelling may be associated with reversible cellular injury)

195

diagnose

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CMV - owl eye inclusions

196

what is calcitriol?

1,25-dihydroxycholecalciferol (ie active form of vitamin D)

197

how will a dose-response curve change if you add a competitive vs non-competitive antagonist to the solution?

competitive = R shift 

non-competitive - shift down

198

palatine tonsils

originates from...

originates from 2nd pharyngeal pouch

199

mild fever + maculopapular rash that spreads from the head inferiorly to the trunk and extremities; resolves in 3-5 d

PE: occiptal and posterior cervical lymphadenopathy

rubella

200

high fever for 3-5d with rash appearing once fever subsides

macules + papules that begin on trunk and spreads to extremities

roseola infantum (HHV6)

201

riboflavin - used to make what? what reactions is it involved in?

FAD, FMN

serve as coenzymes that participate in the TCA cycle as a coenzyme of

  • succinate dehydrogenase (converts succinate into fumarate)
  • Complex I (FMN) /Complex II (FAD)  of the ETC

diagnose w/ RBC glutathione reductase assay or measuring urinary riboflavin excretion

202

why is it that excess alcohol can inhibit gluconeogenesis?

ethanol is metabolized to acetaldehyde by alcohol DH and then to acetate via aldehyde dehydrogenase, and in the process, converting NAD+ to NADH

high NADH favors conversion of

  • pyruvate -> lactate
  • conversion of oxaloacetate -> malate

thereby inhibiting gluconeogenesis

203

tumor cells can become resistant after exposure to various anti-cancer agents. Why?

due to expression of MDR1 (multi-drug-resistance) gene, which codes for P-glycoprotein a transmembrane protein that functions as an ATP-dependent efflux pump

204

gene for both breast cancer + ovarian cancer is on this chromsome

17q (17 is when girl's prime age for developing everything!)

205

male physician spends extra tiem with an attractive F patient but insists that it is because her case is more complicated than the others

rationalization - offering of a false but acceptable explanation for behavior

206

equation for TPR

TPR = (MAP - RAP) / CO

since RAP = 0

TPR = MAP/CO

remember this to help you remember TPR: P = QR

207

brocas and wernicke's area are both supplied by this artery

MCA

208

patient with sx of night blindness, dry skin, and generalized pruritis has which of the following

  • decreased sunlight exposure
  • stright vegetarian diet
  • chronic renal failure
  • prolonged biliary obstruction
  • chronic hemolytic anemia
  • RA

prolonged biliary obstruction - her sx are consistent with vitamin A deficiency. Biliary obstruction -> cholestasis -> fat soluble vitamin malabsorption

209

how do these factors change with ITP d/o?

Platelet Count

Bleeding time

PT

PTT

plasma fibrinogen levels

smear

Platelet Count = decrease

Bleeding time = increase (less platelets)

PT = NC

PTT = NC

plasma fibrinogen levels = normal

smear = isolated thrombocytopenia

usually occurs in females of childbearing age

210

digoxin - MoA 2

OD can result what side effects? 3

what can you treat it with? 2

what worsens digoxin toxicity? 2

BOTTOM LINE - DIGOXIN IS A COMPLICATED DRUG

1) inhibits Na/K ATPase -> decreased Na efflux -> decreased Na/Ca exchanger (pumps Na in, Ca out) -> increased Ca intracellular -> increased contractility

2) increase parasympathetic tone -> increased parasympathetic tone

OD: Hyperkalemia (weakness), blurry yellow vision, life-threatening arrhythmias

trmt: anti-digoxin Fab fragments + Mg

Worse OD w/:

  • age-related decreases in renal function (digoxin is renally cleared; renal fxn declines w/ age and is often not associated w/ a concomitant rise in creatinine since muscle mass also declines w/ age)
  • hypokalemic - K and digoxin competes for the same binding site on Na/K ATPase, there is less K to compete w/ digoxin! 

(compare to hyperkalemia, which reduces digoxin efffect!)

211

Oligodendroglioma

Location

Appearance

Prognosis, presentation

WM of frontal lobe

Chicken-wire capillary pattern w/ fried egg cells (round nuclei w/ clear cytoplasm); often calcified

Adults, Slow growing

212

glyburide, repaglinide, metaglinide

MoA

 

Sulfonylureas - ATP-like molecule that binds to KATP channels on pancreatic ß cells, causing them to close -> depolarization -> VG Ca channels open -> Ca influx -> insulin release via exocytosis

213

radiographic findings of mesotheliomas

diffuse nodular or smooth thickening of the pleura

may present w/  hemorrhagic pleural effusions

214

Female

LH / FSH stimulates which cells? stimulates production of what?

LH = theca (interna) cells; stimulates conversion of cholesterol -> T

FSH = granuolosa cells ; stimulates conversion of T -> estrogen (estradiol)

215

prazosin

major ADR w/ this?

selective alpha -1 blocker that is used in HTN and BPH - peripherally acting vasodilator 

first dose-effect - tendency to cause hypOtension when the first dose is started; prevent by starting off w/ a very small first dose

216

amyl nitrate

use for cyanide poisoning

induces formation of methemoglobin (Fe3+) which cannot carry oxygen, but has a high affinity for cyanide, thereby sequestering cyanide in the blood and keeping it away from mitochondrial enzymes.

217

29yoM w/ scrotal mass (malignant neoplasm) complains of sweating, palpitations, and recent weight loss. Labs show increased T3 and T4. 

What should this make you think of? 

What serum markers would be elevated?

testicular malignancy + hyperthyroidism should make you think of a hCG-secreting teratoma (non-seminomatous germ cell tumor ofen found in testes and ovaries) or seminoma

hCG is similar to TSH, LH, and FSH, therefore it can bind to TSH receptor on thyroid gland -> hyperthyroidism

218

patient on anti-pyschotics develops corneal deposits.

Rx?

chlorpromazine

219

anterior dislocation can result in injury to which nerve?

outcome?

axillary n.

deltoid paralysis, loss of sensation over lateral arm

220

Aspirin should be avoided in all children, with this one exception

Kawasaki's disease

221

What is Reyes Syndrome and what is caused by??

histological findings?

how does this happen?

hepatic failure/dsyfunction + acute encephalopathy (due to hepatic dysfunction)

when a parent treats a viral infection (VZV, influenza B) with ASPIRIN 

histological findings: microvesicular steatosis (ø necrosis or inflammation)

MoA: aspirin metabolism causes decreased ß oxidation of fatty acids 

222

organophosphate poisoning reversed with atropine still puts the patient at risk of this

what's a better option?

muscle paralysis

organophosphate stimulates both N + M cholinergic receptors

atropine reverses M cholinergic receptors only, but does not prevent the development of N effects (ie paralysis)

better option: Pralidoxime - reverses N + M cholinergic receptors by restoring cholinesterases

223

TdT (+), CD19, CD10

ALL - precursor B cell leukemia

224

how does coronary steal work?

in coronary artery disease, coronary vessel occlusion can be bypassed by the presence / recruitment of collateral vessels that allow blood flow to myocardium distal to an occluded vessel. 

Drugs such as adenosine + dipyridamole are selective vasodilators of coronary arterioles. Use of these agents in patients w/ MI can cause vasodilation of these vessels, thus resulting in decreased perfusion within the collateral microvessels that were supplying the ischemic myocardium (ie diverts blood from ischemic areas to non-ischemic areas), leading to hypoperfusion/worsening of existing ischemia

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225

15 M w/ periodic sudden onset of arrhythmic jerking movements, usually happen in the AM and are aggravated by stress or sleep deprivation; denies losing consciousness, but he has fallen during these episodes

dx? trmt?

myoclonic seizures - generalized seizures 

trmt: valproate acid

226

what nerve passes from the obturator foramen?

what happens there is compression of this nerve?

obturator n. - splits into anterior + posterior divisions after exiting the foramen to supply the medial (adductor) compartment of the thigh

therefore, nerve impingement or injury can result in impaired adduction of the thigh

227

in systemic mastocytosis, where the small bowel contains nests of mast cells within the mucosa, what is a common occurence?

gastric acid hypersecretion by parietal cells (due to histamine stimulation)

228

STEMI in I, aVL leads

lateral wall - LCX

229

infant w/ white pupils, hearing loss, and continuous machinery mumur over L infraclavicular area. What could've prevented this?

live-attenuated rubella vaccine

patient has congenital rubella syndrome

classic clinical triad: white pupils (cataracts), deafness, and PDA (heart problems).

 

230

type of hernia that passes through through superficial inguinal ring, but not through the deep inguinal ring

direct inguinal hernia - passes through the inguinal triangle and medial to the inferior epigastric arteries

 

231

what decreases risk of non-hereditary ovarian + endometrial cancers?

increases risk?

decreases: OC, multi-parity, breast feeding

increases: infertility, nulliparity, miscarriages, use of clomiphene citrate (induce ovulation)

232

entacapone

MoA?

COMT inhibitors - prevents levodopa degradation -> more dopamine enters the brain

tolcapone - same thing

233

56yoM has a 20yr hx of alcoholism has increasing confusion + abdominal distension. Massive dilation of what essels will put him at risk of

azygous vein - major accessory pathway for VR in patients with cirrhosis and major outlet for the esophageal venous plexus

In cirrhosis, it can become engorged, making esophageal varices more prone to rupture

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234

Based on the RFLP, at which stage did the non-disjunction occur?

Maternal meiosis I 

Maternal meiosis II

Paternal meiosis I 

Paternal meiosis II

Q image thumb

Paternal meisois II

upper band = mother

lower band = father, but is thicker/darker, which signifies the inheritance of both sister chromatids

A image thumb
235

Type of collagen found when

- macrophages are present

- scar formation is complete

- macrophages:  granulation tissue (type III collagen) 

- scar formation: type I collagen

236

APC chromosome

5q (5 follows the outline of the GI)

237

Based on the RFLP, at which stage did the non-disjunction occur?

Maternal meiosis I 

Maternal meiosis II

Paternal meiosis I 

Paternal meiosis II

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Maternal Meiosis II

lower band = father

upper band = thick, indicating that both sister chromatids were inherited (producing an equal sized restriction fragment, but twice the normal amount)

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238

linear IgG and C3 deposits are characteristic of which renal disease?

Goodpasture - anti-GBM; often accompanied by pulmonary sx (hemoptysis), as well as GBM disruptions + fibrin deposition on EM later on in the disease

239

when lung injury occurs, local neutrophils and macrophages release what cytokines? what do they do?

TNFa, IL1, Il6 - mediate systemic inflammatory response (ie stimulate hepatic production of acute phase reactants, which can increase ESR)

240

26yoF w/ tremors, weight loss, and discomfort on warm days has a palpable unilateral abdominal mass. No ophthalmopathy, no neck masses. Lab shows Low TSH levels. US shows unilateral ovarian cystic mass. DX?

Monodermal Teratoma - Struma ovarii

 

241

what cells provide major proliferative stimuli for the cellular components of atherosclerotic plaques?

platelets - release

  • PDGF - promote smooth muscle migration from the media -> intima
  • TGF-ß - chemotactic for SMC and induces interstitial collagen production

242

4 things that can affect DCML

B12 deficency

Folate deficiency

Vitamin E deficiency

syphillis

 

243

virluence factor of e. coli that causes bacteremia leading to septic shock

LPS - toxin A - causes macrophage activation and widespread release of IL1, IL6, and TNFa

244

Avitaminosis A in CF patients can contribute to?

squamous metaplasia of epithelial lining of pancreatic exocrine ducts (which are already injured and predisposed to squamous metaplasia by inspissated mucus

why? bc Vit A is impt to maintain orderly differentiation of specalized epithelia 

245

sodium (cyanide) nitroprusside test is used in this particular d/o

presence of cystine in the urine since the cyanide added to the urine converts cystIne -> cystEine, then nitroprusside binds the cysteine, resulting in a purple color

Cystinuria - defect in the PCT that causes decreased reabsorption of cystine, ornithine, lysine, and arginine - COLA; cysteine is the only one that will precipitate into hexagonal stones

 

do not confuse w/ nitroprusside - anti-HTN Rx

246

boundaries of inguinal triangle

bound

  • laterally by inferior epigastric a/v
  • medially by the lateral border of the rectus abdominis
  • inferiorly by the inguinal ligament

247

Rx to treat post-op urinary retention

Bethanechol - muscarinic agonist that causes contraction of the detrusor muscle

(or an a1 blocking drug)

248

which organ is supplied by a foregut artery but is NOT a foregut derivative?

 

what other structures does the foregut a. supply?

spleen - derived from mesodermal mesentery - supplied by splenic artery (branch of celiac trunk - foregut)

also supplies:

pharynx -> proximal duodenum
liver
pancreas

249

22yoM w/ skin lesions on abdomen has fibroblasts that can't metabolize ceramide trihexose. He is at greatest risk of...

cardiovascular + renal failure

dz: Fabry - ∆ alpha-galactosidase A - peripheral neuropathy of hands/feet, angiokeratoma, cardiovascular + renal failure problems

250

what kind of withdrawal: confusion, sweating, shakiness, tremulous

alcohol

251

endocarditis due to s. viridans

tooth extraction

252

hemisphere dominant for speech and verbal material in the majority of individuals?

L hemisphere

253

coronary sinus dilation

anything that causes R atrium dilation (ie pulmonary HTN)

254

why can corticosteroids cause reactivation of TB and candidiasis?

blocked IL2 production

255

patient with really high ferritin levels and a (+) family hx  should make you think of...

What other presenting sx do you expect?

how do you treat this?

Hereditary Hemochromatosis - mutation in HFE gene (affect intestinal absorption of Fe that results in iron deposition in the body)

presenting sx: cirrhosis, DM, skin pigmentation, CHF, testicular atrophy

regular phlebotomy, diferasirox, deferoxamine

256

Low MCV

high serum Fe

normal-to-decreased TIBC 

should make you think of...

sideroblastic anemia - abundant iron is available to developing RBCs but it is not used effectievly. Abundant Fe leads to decreased total Fe-binding capacity as the body compensates by downregulating fe-binding capacity

257

23yo w/ confusion has a blood glucose level of 38mg/mL; liver cells have high NADH. Why?

he likely has been consuming large volumes of alcohol lately - the high NADH in the setting of hypoglycemia indicates that a fuel other than glucose is being metabolized (ie ethanol)

ethanol is metabolized to acetaldehyde by alcohol DH and then to acetate via aldehyde dehydrogenase, and in the process, converting NAD+ to NADH

high NADH favors conversion of

  • pyruvate -> lactate
  • conversion of oxaloacetate -> malate

thereby inhibiting gluconeogenesis

258

27yoM w/ dyspnea, chest pain, and severe episodes of post-exertional syncope.

ECHO: anterior motion of hte mitral valve during systole, asymmetric LVH, early closing followed by reopening of the aortic valve

dx and treatment?

patient has hypertrophic cardiomyopathy

Best Rx: ß blockers - slows HR to improve diastolic filling

259

How are intracellular and extracellular K levels different in a patient with DKA ?

intracellular = decreased 

extracellular = normal or increased 

thus DKA patients have a normal-increased serum K levels despite a total K because of:

  • increased plasma osmolality leads loss of intracellular free water loss, results in extracellular movement of K secondary -> increasing intracellular K concentration
  • lack of insulin also causes extracellular shifting of K as insulin normally promotes cellular uptake of K

260

vaginal bx

dx and treatment?

Q image thumb

HSV - ground glass nuclei + intra-nuclear inclusiosn (Cowdry type A), formation of multinucleated giant cells

trmt: acyclovir

A image thumb
261

12yoM w/ turbid plasma that forms creamy-appearning supernatant on standing

likely due to lipoprotein lipase deficiency ->

  • increased conc. of serum chyloµ (hyperlipidemia)
  • pancreatitis (abd. pain)
  • lipemia retinalis
  • eruptive skin xanthomas (mainly on extensor surfaces)
  • hepatosplenomeagly

262

T4 can cannot be converted to T4 and rT3

T3 cannot be converted to T4 and rT3

which statement is true? which one is false?

  • T4 can cannot be converted to T4 and rT3 = FALSE. T4 can be converted to both

 

  • T3 cannot be converted to T4 and rT3 = TRUE

263

Based on the RFLP, at which stage did the non-disjunction occur?

Maternal meiosis I 

Maternal meiosis II

Paternal meiosis I 

Paternal meiosis II

Q image thumb

Maternal Meiosis I

lower band = father

upper + middle bands = mother; ie both homologous chromosomes were inherited, therefore problem occured during meiosis I

 

A image thumb
264

perifollicular hemorrhages hair fragmentation purpura + ecchymoses all over splinter hemorrhages gum changes

Vitamin C deficiency - (vitamin C is impt for collagen formation) - leads to weak blood vessels aka Scurvy

265

drug that can be used to treat bipolar AND seizures?

valproic acid - augments inhibitory actions of GABA in CNS

266

what are howell-jolly bodies?

nuclear remnants within RBCs that are normally removed by the spleen; indicates splenetomy or spleen malfunctioning

267

cells that mediate wound contracture

myofibroblasts

268

hyponotic agent that has anxiolytic, muscle relaxant, and anti-convusalnt actions

benzodiazepines - bind gaba-a receptor and increase frequency of Cl channel opening

269

XY male born w/ feminized external genitalia, but male reproductive tracts and testes in the abdominal cavity.

Dx?

Potential cause?

5a-reducase deficiency - patients remain genotypically F until puberty, when increased T results in virilization (penis at 12 syndrome)

potential cause - Mother was using or handling Finasteride (blocks 5a-R enzyme) during her pregnancy

do not confuse with testicular feminization (androgen insentivity), in which an XY male has neither male nor female reproductive parts (has MIF -> mullerian degeneration, but cells are unable to respond T, therefore Wolffian degenerates), but external genitalia defaults to female phenotype (since the cells can't respond to T)

270

ß endorphin is an endogenous opioid peptide that is derived from?

POMC
undergoes enzymatic cleavage to produce
ßendorphins, ACTH, and MSH

271

F w/ thin, gray malodorous discharge. Culprit?

Gardnerella vaginalis

272

Fondaparinux MoA

 Synthetic pentasaccharide (“extremely LMWH”) that inhibits Factor Xa directly

273

virluence factor of e. coli that causes watery gastroenteritis

heat-stable/heat-labile enterotoxins - promote fluid and electrolyte secretion from intestinal epithelium

274

negative nitroblue tetrazolium test indication of?

measures reactive oxygen intermediates produced by NADPH

if negative -> chronic granulomatous disease (defect in NADPH oxidase); recurrent infections by catalase producing organisms inability to kill bacteria and fungi that are catalase (+)

275

first peak in the jugular venous pressure tracing is due to:

atrial contraction

276

pioglitazone

MoA

What should you check periodically if you prescribe this Rx?

ADR?

contraindications?

Thiazolidinediones (TZD) - binds and activates PPAR-gamma (an intracellular nuclear receptor ) -> increases production of adiponectin (cytokine secreted by fat tissue), thereby reducing insulin resistance (increases sensitivity of target tissues to insulin)

Get LFTS due to risk of severe hepatotoxicity  

ADR: hepatotoxicity**, weight gain, edema**

Contraindications: patients with CHF

277

features of atypical depression?

how to differentiate from major depression?

**mood reactivity** (improvement in mood in response to something positive) = distinguishing feature from major depression

leaden fatigue (arms/legs feel really heavy)

rejection sensitivity (overly sensitive to criticism)

increased sleep and appetitie

278

how does a winged scapula occur?

what are other presenting sx?

damage to long-thoracic n. -> serratus anterior is unable to :

  • hold the medial border and inferior angle of the scapula against the posterior chest wall
  • unable to abduct the arm above the horizontal position, since it is required to rotate the glenoid cavity superiorly

279

breast lump bx shows focal calcifications + multi-nucleated giant cells.

Diagnosis?

Fat necrosis of the breast (likely due to trauma to the breast) -> release lipids that induce chronic inflammatory response -> multi-nucleated giant cells (key to dx)

280

common causes of decreased Mg

diarrhea aminoglycosides diuretics alcohol "DADA"

281

STEMI in V1-V4 leads

anterior wall (LAD)

282

what can reverse vagally-mediated bronchoconstriction?

anti-muscarinics (ipratropium), thereby blocking ACh-induced bronchoconstriction and enhancing bronchodilatory effects of ß-2 adrenergic agents

283

how do you calculate clearance?

clearance = (urine concentration * urine flow rate) / plasma concentration

284

peripheral blood smear looks like this. Dx?

Q image thumb

CLL 

285

What is the pygmalion effect?

researcher's belief in the efficacy of treatment that can potentially affect the outcome

286

budding yeast should make you think of...

cryptococcus neoformans - round/encapsulated cells w/ naorrw based buds (NOT "spherules" which is more indicative of coccidiodes)

287

part of the aorta that is most susceptible to impact injury

aorta isthms, where the connection btwn the ascending + descending aorta occurs (distal to where the L subclavian a. branches off)

288

primary pulmonary artery hypertension is most likely caused by what

AD mutation in BMP-R2 -> vascular smooth muscle proliferation in the pulmonary vasculature and elevated pulmonary pressures 

289

nname this please

Q image thumb

aspergillus

A image thumb
290

recurrent lobar hemorrhages in elderly patient most likely results from...

cerebral amyloid angiopathy - occurs when ß amyloid is deposited into the arterial wall --> weakens it and predisposes it to rupture

NOT related to systemic amyloidsois 

291

small, sterile, fibrinous vegetations along the edges of the mitral valve leaflets; no inflammation

nonbacterial thrombotic endocarditis (NBTE)

aka MARANTIC endocarditis

usually due to

  • hypercoagulable state (cancer ie adenocarcinoma of the pancreas or lung)
    • similar to Trousseau syndrome, where tumors release procoagulants that are responsible for migratory thrombophlebitis
  • endothelial injury

see small, sterile, fibrinous vegetations along the lines of closure of cardiac valve cusps; no inflammation

 

292

uterine smooth muscle contains what kind of receptors? 

which set of these drugs will produce these patterns?

 

Q image thumb

alpha 1 and b2 adrenergic receptors

epinephrine (X) + propranolol (antagonist)

A image thumb
293

24yo AA mother has a child w/ sickle cell anemia decides to remarry. What is the initial best test to offer the family to determine the chances that their next child will be affected.

PATERNAL hemoglobin electrophoresis - why?

woman already has one child w/ sickle cell anemia, indicating that she is obviously a carrier of the trait, so you want to test the father to see if he's a carrier.

294

breathing difficulty due to pain w/ inspiration AND sharp pain in neck in shoulder due to which nerves

phrenic nerve C3-4-5

295

invasive malignancy in the 3rd part of the  duodenum can affect what structures?

ureter

SMA

portal vein

CBD

gastroduodenal artery

SMA 

associations 

1st part - nothing - its the bulb

2nd part - head of pancreas, ampulla of vater

3rd part - uncinate process of pancreas, SMA

296

how does verapamil, a Ca blocker, accelerate the progression/exacerbation of heart failure in certain patients?

strong negative ionotropic effects
 (can exacerbate an already present heart failure (ie post-MI))

constipation

gingival hyperplasia 

297

definition of reassortment

change in genetic composition when host cells are co-infected with two segmented viruses that exchange whole-genome segments; results in sudden alterations of the surface antngens of the viral progeny that is transmitted to the next generation

298

how does blood flow change w/ dynamic (running) vs static (weight lifting) exercises?

dynamic (running)  = metabolic vasodilation of arterioles due to local vasodilator substances

static (weight lifting) = muscle contraction compresses blood vessels, which raises vascular resistance and decreases blood flow during the exercise. reactive hyperemia occurs during the recovery period

299

pathophysiology of alcohol-induced hepatic steatosis

alcohol DH + aldehyde DH -> excess NADH production -> decreased FFA oxidation -> TG accumulation in hepatocytes

300

amt of REM sleep in a patient with major depressive d/o

increase

301

odansetron 

MoA (2)

  • 5HT3 receptor antagonist - blocks vagus-mediated nausea and vomiting (which normally sends info back to the vomit center in medulla)
  • blocks serotonin in the chemoreceptor trigger zone

302

immune response in a patient w/ PID

chlamydia trachomatis - obligate intracellular pathogen, therefore cell-mediated cytotoxicity, a Th1-dominant response) is the primary defense aganist the infection

303

fructosuria

∆ fructokinase --> asymptomatic

304

patient w/ renal cell carcinoma - lesion most likely originated from what part of the nephron/kidney?

histological features?

gross features?

epithelium of PCT 

hx: clear cell carcinoma (most common type; due to high lipid content)

gross features: golden yellow mass

305

urge incontinence

what is it and what is caused by?

treatment?

caused by uninhibited bladder contractions (detrusor instability) that result in sudden sensations of urgency, with involuntary leakage of urine often before reaching the toilet

trmt: M3 (Gq) antagonists (ie oxybutynin) 
-> decreased production of IP3/Ca
-> smooth muscle relaxation
-> decreased involuntary detrusor contractions
-> increased bladder capacity + decreased sense of urgency

ADR: anticholinergic effects: dry mouth, blurred vision, tachycardia, drowsiness, constipation

306

sensory innervation above the vocal cords and below the vocal cords are different. 

above: superior laryngeal, internal br.

below: recurrent laryngeal

307

hapatients who undergo general anesthesia are at great risk of these 2 ADRs

halogenated anesthetics (HALOTHANE, enflurane, isoflurane, and sevoflurane) can cause massive CENTRILOBULAR HEPATIC NECROSIS, as evidenced by increased AST, ALT, and bilirubin levels

usually presents 2d-4wks after exposure 

malignant hyperthermia - when anesthetic is given w/ succinylcholine -> induce fever+severe muscle contractions

trmt: dantrolene (muscle relaxant)

308

amyloid deposit only in heart

transthyretin (cardiac amyloidosis)

309

R nasal hemianopia has damage to

R perichiasmal lesion - ie calcification of ICA impinging on uncrossed, lateral retinal fibers

310

definition of phenotypic mixing

co-infection of a host cell by two viral strains, resulting in progeny virions w/ nucleocapsid proteins from one strain and the genome of the other strain; since there is no ∆ in the underlying viral genomes, the next generation of virions revert to their original, unmixed phenotypes

311

What should you consider in a patient with stable, compensated cirrhosis who suddenly decompensates without apparent reason?

Hepatocellular carcinoma, esp if serum AFP is elevated

312

atrial myxomas

common sx?

what does it like to produce?

scattered cells with mucopolysaccharide stroma, abnormal blood vessels, and hemorrhage - results in a pedunculated and gelatinous structure that can lead to valve obstruction

tend to occur in the LA; causes mid-diastolic rumbling best heard at apex; positional dyspnea 

produces 

  • IL-6 --> constitutional sx (weight loss, fever)
  • VEGF --> angiogenesis

313

MoA of somatostatin in the H-P axis

inhibits GH, TSH

314

a 36yo woman with 5 miscarriages, all which occured in her first trimester. 

cause of her infertility?

suspect a robertsonian translocation in an apparently healthy woman who has many first-trimester spontaneous abortions

315

patient on anti-pyschotics develops agranulocytosis and seizures.

Rx?

clozapine

316

galactose ∆

blood, urine, cataracts (osmotic damage)

317

prevent herpes reactivation with...

daily valacyclovir after the first episode

a short course of acyclovir during the primary herpetic episode just reduces the duration of viral shedding, time for lesional healing, constitutional sx and pain

318

virulence factor of ALL bugs that cause increased cAMP

  • b. anthracis - edema factor acts as an adenylate cyclase -> increased cAMP ->  edema + phagocyte dysfunction
  • bordetella pertussis - pertussis toxin disables Gi -> disinhibits adenyl cylase -> increased cAMP levels -> edema + phagocyte dysfunction
  • ETEC: Heat-labile toxin activates adenylate cyclase -> increase cAMP -> increase Cl/H2O efflux
  • Vibrio cholera - cholera toxin activates Gs -> increase cAMP -> increase Cl/H2O efflux

PETA-Vibes likes to cAMP

319

honey

spores from c. botulinum

320

inflammatory exudate causes rapid neutrophil chemotaxis. What signaling molecule the most responsible? Others that may play a role?

LT-B3 

others: 5-HETE (LT precursor), C5a

Note: LT-C4, D4, and E4 are impt for vasoconstriction, bronchospasm, and increased vascular permeability = role in pathogenesis of bronchial asthma because they cause bronchospasm and increased bronchial mucus scretion

321

what should you treat patients with age-related macular degeneration (AMD) with?

anti-VEGF if it's "wet" AMD - meaning that it is due to abnormal blood vessels w/ subretinal fluid/hemorrhage, gray subretinal membrane, or neovascularization

322

antiarrhythmic drug that causes QT prolongation and also have ß-adrenergic blocking abilities (bradycardia)

Sotalol (other class 3 = amidarone, ibutilide, and dofetilide but these do not have ß adrenergic blocking abilities

323

Stretpomycin MoA

how does resistance to streptomycin develop?

aminoglycoside that binds to 30S ribosome and distorts the structure (thereby preventing bacterial protein synthesis)

resistance acquired via ribosomal gene mutations 

324

acute myelogenous leukemia translocation

AML t15;17

∆ = 2 = hAMLet = 2 syllables

325

What about brown fat causes them to produce heat?

it contains more mitochondria and multiple intracytoplasmic fat vacuoles (compared to white fat, which only has one).

These mitochondria have electron transport and phosphorylation that is uncoupled (ie - the protons pumped out by ETC is returned to the matrix via thermogenin (uncoupling protein) and the energy released by e-transport is dissipated as heat; ø ATP is produced

326

bilateral lens subluxation + stroke should make you think of..

what could've prevented this?

homocystinuria

treatment w/ pyridoxine (B6)

327

drug-induced lupus is usually caused by which Rx?

Who is more likely to develop this?

HIPP = Hydralazine,  Isoniazid (INH), procainamide, phenytoin 

these are metabolized via hepatic N-acetylation, therefore slow acetylators are more likely to develop this (indicating that parent Rx are more likely culprits)

328

what is a glomangioma?

how does it present?

tumor of the modified smooth muscle cells of a glomus body

(glomus body = small encapsulated neurovascular organ found in the dermis of the nail bed, pads of fingers/toes/ears that is connected to a blood supply; functions to shunt bloood away from the skin surface in cold temperatures in order to prevent heat loss and to redirect blood flow to the skin surface in hot environments to facilitate the heat dissipation; ie THERMOREGULATION)

Presentation: small bluish lesion under the nail of the finger that is extremely tender to touch.

329

non-bacterial thrombotic endocarditis associated with disseminated cancer is termed ...

marantic endocarditis

330

patient w/ R sided white pupillary reflex is at risk of developing what two neoplasms

Retinoblastoma 

sarcomas (esp. osteosarcoma)

331

autism chromosome associations

15 and 11

332

csf culture from neonate w/ fever + poor feeding reveals GNR that forms pink colonies on macconkey agar

e. coli - contains K-1 capsular antigen

one of the main causes of meningitis in babies (*BEL*)

333

raltegravir 

integrase inhibitor that disrupts the ability of HIV to integrate its genome into the host cell, thus preventing the host cellular machinery from being used to synthesize HIV mRNA

integrase rategravir

334

What are the functions of these molecules?

ICAM-1

VCAM-1

CD11/18 integrin

LFA-1

VLA-4

Intracellular adhesion molecules (ICAM) = involved in tight binding

Endothelial cells = ICAM-1, VCAM-1

leukocytes: CD11/18 integrin, LFA-1, VLA-4

 

leukocytes = L'A; blood vessels = CAM

335

what opposes insulin action?

glucagon

336

long-acting insulins

Glargine - 1x/day "Glarrrrrrrrrrr" = long

Detemir - 1x/day

NPH - 2x/day

337

common cause of Trisomy 21

non-disjunction at maternal meiosis I 

338

chemoRx associated w/ leg swelling + orthopnea

doxorubicin 

prevent w/ Dexrazoxane

339

definition of transformation

uptake of naked DNA from the environment or incorporation of viral DNA into a host cell chromosome; alters genetic composition of the host cell but typically does not cause genomic change in progeny virions

340

patient w/ acute intermittent prorphyria is deficient in what enzyme and has increased serum levels of..

enz: porphobilinogen deaminase

increased: ALAD and porphobilinogen

341

3 major causes of valvular aortic stenosis

valve w/ calcifications (ie bicuspid valve) calcified normal valve rheumatic heart disease

342

ELISA/WB tests in a recently acquired HIV

falsely (-)

343

Ependymoma

Location

Appearance

Prognosis, presentation

Ventricles, 4th -> hydrocephalus w/ drop metz to the spinal cord to form spinal ependymomas

hx: ependymal pseudorosettes w/ GFAP processes tapering toward blood vessels 

kids dz

344

area implicated in hemiballism

subthalamic nucleus

(involuntary flinging movements is contralateral to the lesion)

345

patient with Myasthenia gravis is started on treatments and complains of abdominal cramping, nausea, sweating, and diarrhea. What can be used to control her new sx?

patient was probably given a cholinesterase inhibitor (AChEi), such as pyridostigmine and is now experiencing ADRs of excessive cholinergic stimulation.

Trmt: Scopolamine - muscarinic cholinergic receptor antagonist will reduce effects of the cholinesterase inhibitor in sites where ACh action is mediated by a muscarinic receptor (ie gut) w/o affecting the action of the cholinesterase inhibitor on skeletal muscles, which use nicotinic cholinergic receptors. 

346

viral infections that usually show atypical (reactive) lymphocytes

atypical lymphocytes are non-specific (as are fever + joint pain), but EBV and CMV usually have the highest counts

347

14yoF w/ development of painful cramps in her legs during exercise. labs show no increase in serum lactate

dx and enzyme?

McArdle disease - lack of myophosphorylase (muscle glycogen phosphorylase) leads to abnormal glycogen accumulation in muscles -> painful cramps + myoglobinuria during strenuous exercise w/o an increase in lactic acid

348

In syringomyelia, where are the affected dermatomes relative to the actual lesion?

1-2 levels below the lesion, since first-order axons ascend slightly in the zone of Lissauer before synapsing)

A image thumb
349

in a woman who is able to conceieve but not maintain a pregnancy probably has a lab serum finding of..?

low progesterone levels - causes endometrium to atrophy and pregnancy to terminate

350

patient on anti-pyschotics develops weight gain.

Rx?

olanzapine

351

sickle cell anemia mutation

glutamic acid -> valine

352

vincristine affects this part of the cell cycle

common ADR of this drug?

how does vinblastine ADR's differ (even though they have the same MoA)

M phase - prevents microtubule formation by binding to ß tubulin (therefore ø mitotic spindle) and therefore failure of division occurs

ADR: peripheral neuropathy

ADR of vinblastine: bone marrow suppression

353

STEMI in II, III aVF leads 

inferior wall (RCA)

may cause sinus node dysfunction

354

loss of knee jerk is usually due to damage to which nerve?

femoral n. (L2-L4)

355

unlar nerve courses btwn these two structures.

injury to this nerve results in:

olecranon + medial epicondyle of humerus

injury - motor + sensory innervation to the last 1.5 fingers of the hand

356

what are pappenheimer bodies?

Fe containing, dark blue granules in wright stain RBC in patients with sideroblastic anemia

357

T/F tetanus can be confirmed by performing a serum toxin assay

FALSE!! There is no serum (or antibody) toxin assay available for tetanospasmin

Diagnosing tetanus = history & physical 

358

defect in NADPH oxidase sequelae

chronic granulomatous disease

incr. susceptibility to catalase + organisms

359

how does epinephrine increase glucose?

  • increased glycogenolysis and gluconeogenesis
  • decrease glucose uptake from skeletal muscles
  • increase alanine release from skeletal m. (subtrate for gluconeogenesis in the liver)
  • increase breakdown of Tg in the adipose (FFA + glycerol substrate for gluconeogenesis in the liver)

 

360

type of diuretic that is implicated for treating HTN or CHF in a woman who is also at risk for osteoporosis

HCTZ - increases absorption of Ca in the DCT 

361

beading along posterior aspect of the chest + lateral bowing of the legs in a 2yo boy

rickets - vitamin D deficiency - rosary chest + genu varus

histologically - there is an increase in unmineralized osteoid matrix + widening between osteoid seams

362

what factors reduce likelihood of gallstone formation? increase?

  • reduce: low cholesterol, high level of bile salts + phosphatidylcholine
  • increase: opposite of ^

363

brain histology - what does this person have?

Q image thumb

Alzheimers

364

pol gene

HIV

contains 3 enzymes - reverse transcrpitase, integrase, and protease

365

when is phenylzine and tranylcypromine usually prescribed for?

MAOi - atypical depression or treatment-resistant depression

 

366

IFNg function

recruits leukocytes + activates phagocytosis

produced by activated T cells and NK cells; function to promote Th1 differentiation, induce MHCII, and activate macrophages

367

What is the MoA of ANP + BNP?

What factor(s) do ANP + BNP counteract?

activates guanylate cyclase, which increases cGMP; subsequently leads to vasodilation, diuresis/naturesis, and decrease in BP

endothelin, sympathetic effects, and AII 

368

generalized edema, proteinuria, hypoalbuminemia, hyperlipidemia, lipiduria

nephrotic syndrome

369

prolonged exposure to loud noises can cause hearing loss due to damage of this

shearing-forces cause damage (distortion/fracture) to teh sterociliated hair cells of the organ of corti

370

What is a common OTC drug that patients with hyperthyroidism MUST avoid?

aspirin and ibuprofen because they displace TH from binding proteins --> worsens thyrotoxic state (acetaminophen is a-OK)

371

6mo F w/ seizures, diminished responsiveness + progressive blindness. PE shows no abnormalities, but fundoscopic exam shows retinal pallor except in the macular area.

D/O & Deficent enzyme?

Tay Sachs - Hexosaminidase A 

TSH

372

in what diseases would you see an elevated AFP?

HCC

non-seminomatous testicular germ cell tumor (ie yolk sac tumor)

373

in what patients would you expect to see idiopathic hypertrophic subaortic stenosis?

typical sx + PE findings?

young adults - thickening of the interventricular septum at the level of the mitral valve 

episodes of syncope, dyspnea, angina, dizziness, or CHF

PE: systolic ejection murmur + thrill, increased ejection fraction, impaired diastolic function

patients are often asymptomatic util they undergo sudden death, usually during strenuous exercise b/c the aortic outlet becomes completely occluded as a result of muscle contraction

374

excess ACh can cause

 

DUMBBELSS

Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation. 

 

375

phenylephrine

paradoxical effects of this?

a1 agonist - vasoconstrictor used in cases of shock or severe hypotension

can cause reflex bradycardia

376

F w/ bloody nipple discharge should make you think of this particular breast cancer

Intraductal papilloma - Small, usually in lactiferous ducts

377

what is the minimal alveolar concentration?

what is this a measure of?

concentration required to prevent movement in 50% of patients when exposed to noxious stimuli

meausre of potency: potent anesthetics have low MAC

378

this a.a. is a precursor for serotonin

tryptophan

379

prolonged bleeding time + thrombocytopenia + giant platelets 

Bernard-Souiler Syndrome

380

Patient w/ Hodgkin lymphoma. What is the expected:

MCV

Serum Iron

TIBC

Ferritin

Anemia of chronic disease; common in patients with hodgkin's lymphoma (or chronic infection, inflammation, cancer)

MCV = low

Serum iron = low

TIBC = low

Ferritin = normal/high

381

patient on anti-pyschotics develops retinitis pigmentosa

Rx?

thioridazine

382

patient on anti-pyschotics develops corneal deposits

Rx?

chlorpromazine

383

patient on anti-pyschotics develops extrapyramidal symptoms

Rx?

haloperidol

384

patient on anti-pyschotics develops prolonged QT

Rx?

ziprasidone

385

patient on anti-pyschotics gains weight

Rx?

olanzapine

386

patient on anti-pyschotics develops agranulocytosis + seizures

Rx?

clozapine

387

epinephrine binds these receptors

a1, b1, b2

388

patient on anti-pyschotics develops retinitis pigmentosa

Rx?

thioridazine

389

glutamate activates what type of receptors? be very specific

NMDA receptor - ligand gated and voltage gated channel

390

Composition of

hemoglobin F

hemoglobin A

F = a2g2 (Fag)

A = a2b2

391

what is retinopathy of prematurity?

neonatal RDS-induced retinal neovascularization (due to temporary hyperoxia as a result of oxygen therapy for RDS), followed by possible retinal detachment and blindness

392

what is the pathophysiology behind a bicornuate uterus? uterus didelphys?

How do these patients usually present?

bicornuate uterus = partial failure of paramesonephric duct fusion; patients have a partially septate uterus attached to a single cervix and vagina

uterus didelphys = complete "" - patients have 2 separate vaginas, cervies, and uterine horns

393

neurons that display cell body rounding, peripheral displacement of the nuclei and dispersion of Nissl substance to the periphery is indicative of:

  • Wallerian degeneration - severed axon degenerates distally and axonal retraction proximally to the site of injury
  • axonal reaction - cell increases proteins in an attempt to repair the axon; cell body shows signs of cellular edema (described above); usually occurs 12-48hrs post injury

394

congenital QT interval prolongation is generally associated with?

K channel abnormalities 

neurosensory deafness (because endolymph is normally composed of high K concentrations and defects in these channels will result in abnormal endolymph production)

395

uniform, diffuse thickening of glomerular capillary walls on LM is seen in which renal disease?

membranous glomerulopathy - most common cause of nephrotic syndrome

396

flutamide

MoA

clinical use

non-steroid anti-androgen that impairs androgen-receptor interaction

prostate cancer

397

Physical differences btwn short stature and achondroplasia?

Short stature (∆ IGF1) - axial and appendicular skeleton are proportionately small 

Achondroplasia (∆FGF-R3 at the epiphyseal plate) - appendicular skeleton is a lot smaller than the axial skeleton

398

FRC 

what is it?

calculation?

where is this on the spirometry graph?

what is the intrapleural pressure at FRC?

point where the PVR is the lowest

tendencies of the chest wall to expand and the lung to collapse oppose one another equally

FRC = RV + ERV

Spirometry graph - at the bottom of the VT trough 

intrapleural pressure at this point = -5 cm H2O

399

22 yo presents to the ED complaining of severe HA and vomiting; slips into coma and dies. Autopsy shows atraumatic head w/ ruptured cerebral aneurysm w/ extensive intracranial hemorrhage.

Dx?

spontaneous intracranial hemorrhage (SICH) - usually due to AVM, ruptured cerebral aneurysm, or cocaine use.

berry aneurysms are prone to rupture when there is an associated coarctation bc of HTN  in the branches of the aortic arch proximal to the coarctation

400

Pathophysiology of Hemochromatosis

typical labs (Fe, 

why do women present later?

trmt?

Hemochromatosis

AR, ø HFE (normally regulates transferrin/Fe uptake)

Labs: elevated Fe, elevated ferritin, >50% TIBC (transferrin sat.)

Classical Triad: skin pigmentation, DM  (2˚ to pancreatic islet destruction), Cirrhosis

Complications: CHF, testicular atrophy, HCC

Trmt: phlebotomy, deferasirox, deferoxamine

Women tend to present later due to blood loss during menstruation + pregnancy

401

rapid treatment of hypoglycemia -induced loss of consciousness in a non-medical setting

IM glucagon - corrects hypoglycemia by increasing hepatic glycogenolysis and gluconeogenesis 

IM injection of hypertonic glucose solutions can damage local tissues and is unpredicatable in systemic absorption

402

toxin responsible for producing bright red tonsils, enlarged anterior cervical LN and skin rash

SCARLET FEVER - complication of strep pyogenes - pyrogenic exotoxin

403

ß glucuronidase

enzyme that deconjugates bilirubin

released by damaged hepatocytes and bacteria 

404

Violent stretch btwn the head and shoulder can result in this particular injury

ERb-Duchenne palsy

damage to musculocutaneous n. + suprascapular n. -> waiter's tip posturing of arm (shoulder adducted, arm pronated, elbow extended)

405

CT findings of constrictve pericarditis

thickening and calcifications of pericardium (bright white outline surrounding heart) sx: slowly

406

sporangium should make you think of...

mold fungi 

407

Diagnosis

Q image thumb

Tzanck smear

multi-nucleated giant cells - HSV

408

patient w/ pulmonary mass complains of dyspnea and hiccups. Why?

pulmonary mass likely impinges upon the phrenic n. C3,4,5 resulting in hiccups + diaphragmatic paralysis w/ dyspnea

409

benzos that have a short half-life.

why is this impt?

Triazolam

Alprazolam

Oxazepam

"TAO"

impt for reducing daytime drowsiness/"hangover" effect that can impair judgement and concentration, and cause ataxia (increased risk of falls)

on the flip side, this can cause a makes it so that it has a higher addictive potential

410

What are Clara Cells and what is their role in the body?

non-ciliated, secretory cells present in the terminal respiratory epithelium; secrete stuff that inhibit neutrophil recruitment and activation

411

MoA of mifepristone

vs

MoA of misoprostol

mifepristone (RU486) = progesterone receptor antagonist - results in decidual necrosis + expulsion of products of conception; used as an abortifacient (up to 49d post-conception) since progesterone is necessary for implantation and maintenance of pregnancy

misoprostol = prostaglandin analog - causes uterine contractions + cervical dilation; also used to prevent NSAID-induced ulcer dz

don't confuse them!!!

412

patient with increased susceptibility to encapsulated, pyogenic bacteria (strep. pneumo, h. influenza, pseudomonas)

Bruton X-linked agammaglobulinemia (absence of C19+)

413

virluence factor of e. coli that causes bloody gastroenteritis

verotoxin (shiga-like toxin) - inactivates 60S component, halting ribosomal protein synthesis and causing cell death

414

5yo w/ fever, abd pain, diarhea mixed w/ small amounts of blood who develops marked pallor and oliguria should make you think of...

what test is going to be abnormal?

HUS - EHEC 0157-H7

bleeding time will be abnormal since widespread capillary thrombi consume platelets (also cause schistocyte formation) -> pallor, weakness, and tachycarida (compensatory response)

thrombocytopenia -> petechiae + purpura

labs: decr. hemoglobin, hct, RBC count

labs: increased LDH and reticulocytes, bleeding time (due to reduced platelets)

labs: normal coagulation studies because there are no clotting factor deficiencies or DIC associated with HUS

 

415

chromogranin A is a marker of...

neuroendocrine cells

416

amlodipine

MoA

clinical use

ADR

Ca channel blocker - selective for arteriolar smooth muscle

(decrease SVR and thereby decrease afterload + cardiac work)

HTN

flushing, peripheral edema (bilateral ankle swelling)

417

damage to tibial n. results in..

 

weak plantarflexion (ie foot is held in unopposed dorsiflexion) and weak inversion of ankle (ie food is held in eversion), inability to curl toes

loss of sensation over sole of foot

A image thumb
418

damage to common peroneal n. results in..

 

weak dorsiflexion (ie foot drop) and weak eversion of ankle (ie food is held in inversion)

loss of sensation over dorsum of foot

A image thumb
419

primary virulence factor of s. pneumoniae?

polysaccharide capsule

IgA protease

420

Segmented viruses

  • Bunyavirus (california encephalitis, sandfly/Rift valley fever, crimean-Congo hemorrhagic fever, Hantavirus
  • Orthomyxovirus (influenza)
  • Arenavirus (LCMV, Lassa fever encephalitis)
  • Reovirus (rotavirus)

capable of genetic shifts through reassortment 

421

cohort study

compares a group with a given exposure or risk factor to a group without. LOOKS TO SEE IF EXPOSURE INCREASES LIKELIHOOD OF DISEASE

422

why would someone with acute pancreatitis (AST156, ALT 44) have a mean corpuscular volume of 108fL?

dude likely has OH abuse (his AST/ALT ratio is >2, which is indicative of alcoholic hepatitis) 

chronic alcholism -> vitamin associated deficiencies (B12/Folate) -> macrocytosis

423

T/F aspirin is an effective anticoagulant for DVTs

T/F aspirin is an effective anticoagulant for MIs/ischemic stroke

F

T - aspirin is commonly used in patients who have had a TIA to prevent 1˚ or 2˚ coronary artery events and ischemic strokes

424

MoA of TRH in the H-P axis

stimulates TSH + prolactin release

425

23yoF with chronic viral hepB on liver bx.

presence of which serological marker is most likely to increase risk of vertical transmission of the virus?

what should you do?

HBeAg = marker of viral replication and increased infectivity

newborns: passive immunization with HepB Ig, followed with active immunization with recombinant HBV vaccine

426

in SLE, how does thrombosis occur? Libman-Sack's endocarditis?

hypercoagulable anti-phospholipid antibody syndrome

IC deposition on the cardiac valves -> fibrosis

427

patient started on an anti-coagulant comes in 2 weeks later complaining of this. What was this patient given and what is his problem?

Q image thumb

warfarin

he's probably protein C deficient - which lead him to a relatively hypercoagulable state with thrombotic occlusion of the microvasculature and skin necrosis

428

source of blood in lateral ventricles of a preemie

germinal matrix- highly cellular + vascularized layer of the SVZ

BV are thin and lack the glial fibers that normally support the blood vessels, thereby increasing its risk of hemorrhage

occurs only in preemies because the germinal matrix becomes less prominent and its cellularity and vascularity decrease, thereby reducing the risk of intraventricular hemorrhage

429

drug for patient with both absence and tonic clonic seizures

valpric acid 

(ethosuximide does not effective against tonic clonic seizures)

430

nifedipine

moA

peripherally acting Ca channel blocker -> reflex tachycardia

431

histology of type I dm? type II dm?

type I - leukocytic infiltrate of the islet

type II - islet amyloid deposition (IAPP)

432

PKU inheritance

AR

433

greast risk of long-term exposure to asbestos

bronchogenic carcinoma - 1st leading cause of death in this population

mesothelioma - 2nd leading of death

434

combination of 

low MCV

normal serum Fe

normal TIBC

should make you think of..

thalassemia minor or lead poisoning 

435

N-myc is a marker of...

neuroblastoma and small carcinoma of the lung

436

patients on clozapine should be monitored for...

seizures

CBC - can cause agranulocytosis

(MoA: acts on D4 receptors)

but note that it is an atypical antipsychotic that is less likely to cause EPS

437

cytokine that inhibits Th1 cells

IL-10 (produced by TH2 cells

438

which organ has an O2 extraction that exceeds that of any other tissue or organ in the body?

heart - resting myocardium extracts ~75% of the O2 present in the blood, while the myocardium at work extracts up to ~90% of the O2 in the blood

439

prolonged bleeding after tooth extraction and surgeries can be of two things. What can distinguish between them?

can be hemophilia A or vWF d/o

Hemophilia A = spontaneous hemoarthroses, prolonged PTT

vWF = prolonged PTT and prolonged bleeding time

440

Prolactin in the H-P axis

what factors can stimulate its release? inhibit it?

inhibits GnRH ->  decreased LH/FSH/sex hormones, thereby causing impotence in M and amenorrhea in women of reproductive age; aka "hypogonadotropic amenorrhea"

it is inhibited by Dopamine, and stimulated by TRH (in cases of severe hypothyroidism)

dopmaine antagonists (bromocriptine) are used to treat prolactinomas

anti-psychotics (dopamine antagonists) - galactorrhea

441

Which parts of the inner ear is best suited to detect high frequency sounds? low frequency sounds?

high frequency: base of the cochlea, near the oval/round windows

low frequency: apex of of the cochlea, near the helicotrema

"It's low-ny at the top (apex)"

(can think of the base as having a wider area = big; high,
whereas the apex has a smaller area = small; low)

A image thumb
442

Patients w/ Trisomy 21 are at increased of 3 diseases

childhood: AML-M7, ALL
adulthood: Alzheimers

443

how does carotid sinus massage affect PaO2 and PaCO2?

causes reflex vagal discharge to the SA node, atrial myocytes, and AV node -> HR + CO is also decreased but carotid sinus massage would n​ot signfiicantly affect the PaO2 or PaCO2

444

in what ways can you think of someone with ß thalassemia major experiencing heart failure?

these patients require a lot of transfusions, resulting in an Fe overload that results in hemosiderosis that can contribute to cardiac failure

The heart is damaged by the chronic high CO state needed to compensate for the anemia.

445

paraneoplastic syndromes of renal cell carcinoma (2)

EPO -> polycythemia

PTHrP -> hypercalcemia

446

what is the scala media composed of? What does it house?

endolymph; houses the tectorial membrane + organ of corti

447

surgeon w/ shaky hand was trying to ligate the inferior thyroid a. and accidently severed this nerve and its innervation to these structures

recurrent laryngeal n.

innervations: all laryngeal m. (except cricothyroid) and sensory innervation below the vocal cords

448

endocarditis with vegetations + negative blood cultures

HACEK organisms (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

449

diffuse large b-cell lymphoma translocation

follicular t14;18; 4 = “four”llicular

OR

diffuse large b-cell lymphoma t14;18 = 4 words

450

L atrium enlargement can result in:

L recurrent laryngeal impingement difficulty swallowing

451

mother dx w/ GBS - what should you do?

give INTRApartum penicillin or ampicillin

452

common cause of oxalate stones in an alcoholic homeless with vomiting and prolonged oliguria. 

ethylene glycol

increased osmolar gap with AG acidosis

453

Pilocytic astrocytoma

Location

Appearance

Prognosis, presentation

 

Cerebellum

Cystic tumor w/ nodule on the wall; pilocytic astrocytes (GFAP +), eosinophilic rosenthal fibers

Kids

Low-grade tumor

 

454

gluteus maximus functions in

hip extension

455

acute intermittent porphyria can be preciptiated by which epilepsy Rx?

phenobarbital  (increases GABAA action)

other ADR: sedation, cardiovascular + respiratory depression

456

cause of pharyngitis and myocarditis

corynebacterium diphtheriae

457

Name these strctures

Q image thumb

A = globus pallidus

B = putamen

C = internal capsule

D = caudate nucleus

E = amygdala

458

leading cause of chronic bronchitis

smoking

459

kappa and delta opioid receptors

excessive stimulation results in

mioiss 

dysphoria

sedation

antidepressant effects

460

Rx that activates PPAR-gamma is used for...?

activation of this receptor does what?

Thiazolidinediones (TZDs) - exert their glucose lowering effect by binding to PPAR-gamma receptor, thereby activating genes (ie adiponectin) involved in glucose + lipid metaolism

net: decreased insulin resistance

461

what dopaminergic pathway connects hypothalamus and pituitary gland? such that it allows DA to inhibit PRL secretion?

tuberoinfundibular dopaminergic pathway

462

G6PD inheritance

X-Linked Recessive

463

schoolboy acts cruelly to a girl that he actually likes

reaction formation - adoption of a behavior that is opposite to that of one's true feelings

464

name this please

Q image thumb

mucormycosis 

branches at 90˚

A image thumb
465

CA-19-9

pancreas adenocarcinoma - marker for tracking tumor recurrence, but not screening

466

what factors act through GPCRs?

peptide hormones (glucagon, PTH, ACTH, gonadotropins)

467

corneal reflex involves which 2 cranial n.?

afferent: CN V1 

efferent: CN VII (enters the orbit via superoir orbital fissure)

468

mastectomy can injure what nerve? effects of this?

long thoracic - winged scapula + inability to abduct arm above the horizontal plane

469

viruses with segmented genome

ROBA

rotavirus (reovirus)

influenza (orthomyxovirus)

lymphocytic choriomeningitis california encephalitis (bunyaviridae) 

virus (arenavirus)

470

how do these viruses enter the cells?

CMV

EBV

HIV

Rabies

Rhinovirus

 

CMV: cellular integrins

EBV: CR2/CD21

HIV: CD4, CXCR4, CCR5

Rabies: Nicotinic ACh receptor

Rhinovirus: ICAM

471

treatment for OCD

TCAs (clomipramine) or SSRIs

472

where are there high expiratory flow rates in restrictive lung diseases?

1) low lung volumes due to increased elastic recoil pressure

2) increased radial traction on the conducting airways by the fibrotic pulmonary interstitium 

473

location of the great saphenous vein relative to the small saphenous vein?

great = medial aspect of the leg, courses upwards medially and drains into the common femoral vein just inferolateral to the pubic tubercle

small = lateral aspect of the leg; courses posteriorly to drain into the popliteal vein

A image thumb
474

initial cellular event triggered by Digoxin

decreased Na efflux (via inhibition of Na/K/ATPase) ultimately results in AV nodal blockage

475

how does damage to the inferior parietal lobe of the dominant hemisphere differ than that of the non-dominant hemisphere?

  • dominant = Gerstmann syndrome - R/L confusion, dysgraphia, dyscalculia, and finger agnosia 
  • non-dominant = apraxia (inability to execute learned purposeful movements despite having the desire and physical capacity to perform the movements), contralateral hemi-neglect

476

45yo w/ pelvic pain that is worse before and during menstrual period. US shows non-focal thickening of the myometrium w/ normal ovaries. Pap + bimanual exam is normal. Dx?

Adenomyosis - presence of endometrial glands in the myometrium of the uterus in addition to their normal location in the endometrium. They undergo cyclic changes w/ menstrual cycle in response to the same stimuli as the normal endometrial glands. 

477

brain tumors that are prevalent in the adults

Schwannoma

acoustic neuroma

Glioblastoma multiforme

meningioma

Oligodendrioma

 

ADULTS SAG MO'

478

long crystals that are negatively birefringent under polarized light are of what composition?

monosodium urate (uric acid salt) - is what accumulates in the synovial fluid and forms crystals that deposit in the synovium and cartilage

479

F w/ breast pathology that looks like this. What is her diagnosis?

what other findings should you expect?

Q image thumb

paget's - should see eczematous patches on nipple. 

cells seen are paget's cells = large cells w/ clear halo confined to the epidermis

480

What is Von Recklinghausen's disease?

NF-1 - inherited peripheral nervous system tumor

481

2 symptoms of CN 3 palsy 

somatic:

  • down and out gaze (∆ innervation to inferior, superior, medial rectus, inferior oblique)
  • ptosis (∆ innervation to levator palpebrae)

parasympathetic

  • fixed, dilated pupil, loss of accomodation (∆ iris sphincter, ciliary muscle)

482

mercaptopurine affects this part of the cell cycle

common ADR of this drug?

how is it mostly cleared?

S. phase - purine analog that inhibit de novo purine synthesis after being converted to active metabolites by HGPRT

ADR: cholestasis, hepatitis (ie abd. pain, jaundice)

mostly cleared by xanthine oxidase (since they are purine analogs) in the liver

483

how do central chemoreceptors differ than peripheral chemoreceptors in terms of location + what they detect?

what happens in COPD patients?

Central: medulla, detect ∆H (CO2; main stimulator of respiratory drive)

  • note that chronically elevated CO2 levels result in desensitization (ie CO2 ceases to stimulate the respiratory drive) and O2 is the only stimulator of respiratory drive. Therefore giving supplemental O2 to COPD patients decrease respiratory drive, since the body thinks that there's enough O2!!)

Peripheral = carotid/aortic bodies; detect ∆O2

484

HIV patient who is non-adherent with his meds have a:

  • colonoscopy = reddish violet flat maculopapular lesions or hemorrhoragic nodules
  • hx = spindle shaped tumor cells with small vessel

kaposi sarcoma (HHV8)

485

2 causes and effect of congenital torticollis

birth trauma (breech delivery)

malposition of the head in utero (fetal macrosomia or oligohydramnios)

effect: SCM injury + fibrosis; head tilts towards affected site w/ the chin pointed away from the contracture

486

how to destroy hepA infection?

treat w/ acid

heat to 60˚C for 1 hr

boiling for 1 minute

treat w/ diethyl ether

drying

F/O transmission = inactivated w/ water chlorination, bleach, formalin, UVR, boiling for 1 min

methods that do not work:

  • drying = stable
  • ø lipid soluble envelop = resitant aganist diethyl ether, chloroform
  • acid = HepA can withstand the acidic gastric environment (F/O, remember?)
  • Heating to 60˚C will not inactivate it

487

What is the Berkson's bias?

selection bias created by selecting hospitalized patients as the control group.

488

how do these factors change with Bernard Soulier d/o?

Platelet Count

Bleeding time

PT

PTT

ristocetin response

Platelet Count = NC to decreased

Bleeding time = increased

PT = NC

PTT = NC

ristocetin: abnormal

489

34yoM asthmatic develops wrist drop. CBC shows elevated eosinophils. Dx?

Churg-strauss syndrome - p-ANCA (myeloperoxidase)

  • Wrist drop - develops secondary to a radial n. mononeuropathy, polyneuropathy
  • adult-onset asthma
  • eosinophilia
  • hx of allergy
  • migratory/transient pulmonary infiltrates
  • paranasal sinus abnormalities

490

44yo w/ nuchal rigidity. gram stain would most likely show...

lancet shaped, GP cocci in pairs = STREP pneumo 

most common cause of bacterial meningitis in adults

consider N. meningitidis only in outbreaks where individuals live in close quarters (ie dorms)

491

cardiac findings in digeorge syndrome

tetralogy of fallot, aortic root anomalies

492

warfarin - what factor is most implicated in skin/subcu fat necrosis?

inhibition of protein C activity can predispose patients to warfarin-induced skin necrosis. often seen in patients with protein C deficiency

493

reliability vs accuracy in terms of a particular lab test

  • reliability = reliable test is a reproducible test in that it gives similar results on repeated measurements
  • accuracy (validity) = test ability to measure what it is supposed to measure; must be compared to the gold standard 

494

Female that has not yet begun menstruating has a shallow vagina, no palpable uterus, palpable masses in the labia majora. What does she have?

androgen insensitivity (testicular feminization) 

phenotypically female but genetically XY

(SRY -> MIF -> regression of mullerian ducts, but cells can't respond to T which results in external female development) 

495

what drug is used to control severe Grave's ophthalmopathy? (edema and infiltration of lymphocytes into the extraocular muscles and CT)

glucocorticoids

496

definition of recombination

exchange of genes between two chromosomes by crossing over within homologous regions; genetic changes will be passed down to subsequent generations

497

"jaundice and exertional dyspnea" should make you think of...

A1AT deficiency 

 

498

eye field looks like this:

where is the lesion?

Q image thumb

R parietal lobe (dorsal optic radiation)

G

A image thumb
499

genetic defect that leads to diminished proliferation of chondrocytes in the growth plate of long bones

achondroplasia - constitutive activation of fibroblast growth receptor inhibits chondrocyte proliferation (∆cell signaling)--> dwarfism

500

indicator of severity of a mitral reguritation

presence of audible S3 - reflects an increased rate of LV filling due to a large volume of regurgitant flow re-entering the ventricle during mid-diastole

501

liver bx: extensive lymphocytic infiltration + granulomatous destruction of interlobular bile ducts

primary biliary cirrhosis 

(increase serum-mitochondrial antibodies)

pruritis is often the first symptoms and may be very severe, esp at night. 


hx: destruction of intralobular bile ducts by granulomatous inflammation and infiltrate of macrophages, lymphocytes, plasma cells, eosinophils
 

502

how is a non-capsule forming strain of s. pneumo able to acquire genes that encode for the capsule and gain virulence?

transformation - acquisition of genetic material following the death/llysis of neighboring bacterial cells

other bacterias have the same ability to do so:

H. influenza

Neisseria gonorrhea and meningitidis

503

vimentin is a marker of...

mesenchymal cells

504

penicillamine is used to treat what d/o?

Wilson's disease - AR d/o characterized by toxic accumulation of Cu within organ tissues (esp of the liver, brain, and eye)

Penicillamine is basically a chelator that removes excess copper in tissues

505

first EKG signs of acute transmural MI

peaked T waves (localized hyperkalemia)

followed by STEMI

followed by Q waves

506

Weightlifter lifts a very heavy bar over his head for a few seconds and suddenly drops it to the ground. What is the physiology behind this?

Golgi-tendon organs (GTO) - receptors at the junction of muscle + tendon; innervated by sensory axons (Grp Ib)

GTOs are activated when a muscle actively contracts against resistance, results in stimulation of inhibitory interneurons in the spinal cord, which inhibit contraction of the muscle. -> results in sudden muscle relaxation (prevents damage to musculoskeletal system, esp when a muscle exerts too much force)

 

A image thumb
507

Piriform recess in the pharynx contains

where food is directed as the epiglottis folds down on the laryngeal opening

contains the internal laryngeal n. (br. of superior laryngeal n. of CN-X)  that mediates afferent limb of the cough reflex - damage to this may result in ø cough reflex 

A image thumb
508

how does an indirect/direct inguinal hernia differ in terms of the layers that encase it?

what is it caused by?

how do they each present?

indirect = Li

  • covered by all 3 spermatic layers
  • failure of the processus vaginalis to obliterate
  • hydrocele

direct = Md

  • covered only by the external spermatic fascia
  • weakness of the abdominal wall/transversalis fascia (@ hesselbach's triangle)
  • buldge on the groin that increases w/ during straining

509

last feature to disappear along the bronchial tree

serous glands

clilia

goblet cells

mucous glands

cartilage 

cilia - prevents bronchiolar mucus accumulation and airflow obstruction; persist up to the end of the respiratory bronchioles

mucus + serous glands travel within the cartilaginous plates and end at hte smallest bronchi (bronchioles lack these features)

510

why would someone w/ severe aortic stenosis suddenly have heart failure?

a-fib 

severe AS may already have reduced CO and this may be exacerbated by the sudden loss of normal atrial contraction that contributes significantly to ventricular filling

these patients depend on atrial contraction and w/o it, LV preload can decrease to the point of producing severe hypotension.

511

17yo man w/ fever, sore throat, and cervical + axiallary lymphadenopathy. Dx? 

Q image thumb

infectious MONO; picture: Downey cells

note - there are multiple causes of pharyngitis, but generalized lymphadenopathy is common w/ infectious mono!!

(do not confused with smudge cells (pictured below)

A image thumb
512

pyrophosphate analog that is used to treat osteoporosis

bisphophonates - alendronate, risedronate, ibandronate

makes hydroxyapatite more insoluble; decrease bone resorption by interfering w/ osteoclasts function

*patients must stay upright for at least 30 minutes to prevent reflux because these agents can cause stomach/esophageal inflammation + erosions*

513

fatty streaks begin as flat yellow spots on the inner surface of the aorta. When do these normally start appearing?

in children as young as 1 years old and are present in the aortas of all children over 10

514

how does an AVM affect cardiac circulation?

AVM shunts blood directly from Arterioles -> Venous system (bypassing arterioles)

--> increase preload by increasing the rate and vol. of blood flow back to the heart

--> decrease afterload/TPR  since blood is allowed to bypass the arterioles (long-term response: sympathetic activation + kidneys -> increase MSFP) 

515

definition of uniparental disomy 

when do you normally see this?

when a fetus inherits 2 copies of homologous chromosomes from ONE parent and NO copy from the other parent

ex: hydatidiform mole

516

c. perfringenstoxins

alpha toxin - lecithinase

causes clostridial myonecrosis (gas gangrene) - a rapidly progressive form of fasciitis that is associated with penetrating injury by soil contaminated objects

517

c. diff toxins

toxin A - neutrophil chemotrractant -> inflammation -> mucosal death

toxin B -> actin depolymerization -> ∆ cellular integrity, death, and mucosal necrosis

both inactivate Rho - involved in signal transduction and actin cytoskeletal structure maintenance -> disrupts tight junctions, leading to increased paracellular intestinal fluid secretions as well as cell rounding/retractions

518

which two cell types in the body can't use ketone bodies for energy and why?

RBC - lack mitochondria

hepatocytes - lack thiophorase (succinyl-CoA-acetoacetate CoA transferase). note: ketones are produced in the liver even though they can't use it!!

519

what 2 factors cause insulin resistance in overweight individuals??

FFA and serum Tg

520

what is the specific site in the inner ear where sound is transduced into the nervous system?

organ of corti

521

Role of muscle spindles?

aka intrafusal muscle fibers (connected in parallel with extrafusal fibers, innervated by grp IA and grp II sensory axons)

mediate stretch reflex (myotactic reflex) which is commonly tested via deep tendon reflexes

when a muscle is stretched, reflex activation of the a-motor neuron causes contraction to resist the stretch

522

Which one corresponds to this graph?

Acute GI bleed

Pyschogenic polydipsia

Diabetes insipidus

Hypertonic saline infusion

Q image thumb

Acute GI bleed - isotonic loss of  ECF volume (ø osmolarity change, therefore normal ICF and decreased ECV); aka iso-osmotic volume contraction

diarrhea would result in a similar looking graph

523

72 M develops hypotension during surgical repair of abdominal aortic aneurysm. What part of the large bowel is most likely to be affected?

Splenic flexture + distal sigmoid colon = both are watershed area  that are most susceptible to ischemic damage during hypotension/low perfusion states

524

opsonic antibody

IgG - binds to Fc receptors to enhance speed of phagocytosis

525

saccular aneurysms

where do they occur?

why do they occur?

rupturing of these can result in?

"Berry aneurysms"

typically within the circle of willis

occur due to hereditary weakness of blood vessels (ADPKD, Marfans, Ehlers-Danlos"

subarachnoid hemorrhage (WHOML)

526

nitroprusside moa

venous + arterial vasodilator that decreases BOTH preload and afterload; resulting in maintained SV

527

ddx of mitral valve thickening w/ vegetations

infectious endocarditis

rheumatic disease 

Libman sacks- endocarditis associated wtih SLE

non-bacterial endocarditis

528

what does this patient suffer from?

Q image thumb

lead poisoning -  basophilic stippling on a background of hypochromic microcytic anemia.

stippling = abnormal aggregation of ribosomes

hypochromic microcytic anemia = ALAD inhibition -> reduced Fe incorporation into heme -> decreased Hb synthesis

529

pt. w/ grayish pharyngeal exudate + enlarged cervical nodes and partial soft palate paralysis bacteria produces exotoxin - what is the MoA of this toxin?

ribosylates and inactivates elongation factor 2 (EF2)

530

hormone profile of PCOS in terms of

GnRH

LH

FSH

estrogen

androgens

GnRH = elevated

LH = increased

FSH = low (not enough to recruit dominant follicle)

estrogen - may be low (due to low follicular maturation) or elevated

increased androgen production

531

21yo M patient w/ progressive impaired balance, difficult speaking; has elevated AST/ALT. Hx is otherwise unremarkable. 

Diagnosis? Labs?

Wilson's disease

low ceruloplasmin (

increased Cu excretion

Kayser-Fleischer rings (Slit lamp examination)

532

18yo M suddenly collapses and dies. Autospy likely shows...

hypertrophic cardiomyopathy (esp of the interventricular septum)

(don't confuse w/ "endocardial thickening and non-compliant ventricular walls", which is indicative of restrictive cardiomyopathy; often leads to CHF)

533

agent that blocks inositol triphosphate interaction w/ its intracellular receptor would most likely decrease the activity of..?

protein kinase C

remember: PLC -> IP3 + DAG

IP3 -> Ca release from SR

DAG + Ca -> PKC activation

 

534

Describe process of B12 absorption (from the mouth -> terminal ileum)

  1. salivary glands secrete R protein (haptocorrin), which binds B12 (protects it from denaturation by gastric acid)
  2. complex reaches the duodenum, where pancreatic proteases cleave the R protein to release B12, which then binds to IF (prevents digestion in the small intestines and also facilitates its absorption in the distal ileum)

535

resected testes show non-encapsulated, yellow, mucinous mass w/ endodermal sinuses. Tumor marker?

AFP - this is a yolk sac tumor. the endodermal sinuses are actually schiller duval bodies 

536

what factors signal through nuclear receptors?

thyroid hormone

retinoids

peroxisomal proliferating activated receptors

fatty acids

537

virluence factor of e. coli that causes neonatal meningitis

K1 capsular polysaccharide - prevents phagocytosis and complement mediated lysis

538

at low doses, dopamine stimulates which receptors?

high doses?

even higher doses?

  • low doses: D1 receptors in renal vasculature -> increase GFR, RBF, Na excretion
  • high doses: ß1 receptors in the heart -> increase contractility, PP, systolic BP
  • even higher doses: a1 receptors in systemic vasculature -> vasoconstriction (-> decreased CO due to increased afterload)

doped but amped

539

drug that is causes disturbed color perception + its ADR (2) treatment?

digoxin ventricular tachycarrhythmias hyperkalemia trmt: anti-digoxin antibody fragments

540

80yo man w/

creatinine: 2.0 mg/dL

BUN: 65 mg/dL

FeNa is 4%

Diagnosis?

BPH

note that his BUN/creatinine ratio is 62/2 = ~32, which is greater than the normal 12-20 for individuals on a normal diet. 

High ratios w/ elevated creatinine levels are due to POST-RENAL OBSTRUCTION, ie BPH or POST-RENAL AZOTEMIA

541

baby boy at 37wks gestation shows a unilateral testicular mass.

Gross Hx shows homogenous, yellow-white in color

Hx shows epithelial lined spaces w/ flattened to cuboidal epithelial cells w/ vacuolated cytoplasm containing eosinophilic, hyaline-like globules. Scattered primitive glomeruli is observed.

eosinophilic hyaline-like globules will stain for what?

AFP + A1AT

(indicates yolk cell differentiation)

542

treatment of extra-pyramidal sx (cogwheel rigidity, resting tremor, masked facies, bradykinesia) caused by first-generation anti-psychotics

anti-muscarinic Rx (trihexyphenidyl, benztropine)

DO NOT USE LEVODOPA, or BROMOCRIPTINE because it can preciptate or exacerbate psychosis, respectively

543

mother taking her anger out on her son, who in turns, yells at his little sister

displacement

544

why is it that thyrotoxicosis (thyroid storm) results in hyper-adrenergic manifestations (ie racing heart, insomnia, SOB)

TH upregulates ß adrenergic receptor expression (also reason why ß blockers are used to treat thyroid storm!!!)

545

tachyphylaxis - what is it?

rapidly declining effect of drugs (such as phenylephrine or NTG) after a few days of use - occurs bc of a decreased production of endogenous NE or NO from the nerve terminals due to (-) feedback mxn, resulting in relative vasodilation and subsequent edema + congestion)

patients tend to see rebound rhinorrhea, edema, congestion w/ this

stop Rx to allow restoration of normal NE/NO feedback pathways

 

546

what stain is this? what is it used for?

Q image thumb

prussian blue stain - stains iron; used to diagnose hemochromatosis

547

what should one do after D&C of hydatidiform mole??

serial measurements of ßhCG levels; if elevated or rising, it may signify the development of an invasive mole or choriocarcinoma

548

patient with CREST is at risk for developing what?

accentuated 2nd heart sound

pitting edema

hepatomeagly

ALL BECAUSE of intimal thickening of pulmonary arterioles (due to increased collagen deposition) --> leads to narrowed lumens and increased pressure in the pulmonary circuit --> Pulm HTN --> R sided CHF

549

chronic myelogenous leukemia 

CML t9;22

∆ = 13 = rotate the 13 90˚ = CaMeL has 2 humps on its back

550

Glioblastoma multiforme

Location

Appearance

Prognosis, presentation

Hemispheres (frontal, temporal, or near basal ganglia); can cross midline “butterfly glioma”

Pseudopalisading pattern = central areas of necrosis and hemorrhage (ring enhancing lesion); GFAP (+)

Adults, Poor prognosis (1 yr survival)

551

ascending muscle weakness after GI or respiratory infection

name of dz and common culprit

Guillain-Barre Syndrome

Campylobacter jejuni

552

most important hormones to replace in hypopituitarism

corticosteroids and thyroxine

553

MoA of hydroxyurea

increase Hg F synthesis such that it confers protection against the polymerization of sickle cells

554

what molecules signal through TK associated receptors?

cytokines (ie IL-2)

GH

prolactin

all act via JAK/STAT pathway

555

Bony metz = if osteoblastic + osteolytic, you should think of...

breast cancer

556

what does it mean when the arteriovenous concentration gradient of a gas anesthetic is LOW in terms of

tissue solubility

time to reach blood saturation

brain saturation

  • low tissue solubility (ie a small amt of anesthetic is taken up from arterial blood, which results in high venous concentration)
  • time to reach blood saturation = faster
  • brain saturation = faster because of the factors above

557

How is copper absorbed from the body? Removed?

Ingested Cu is absorbed in the stomach + duodenum and transported to the liver, where it is conjugated w/ a2-globulin to form ceruloplasmin, which is then resecreted into plasma

Ceruloplasmin + unabsorbed Cu is secreted into bile and excreted into stool, which is the 1˚ route for Cu elimination

558

what should you check in a patient w/ bitemporal visual field deficits w/ a history of hypercalcemia?

pancreas tumor (MEN1) - pituitary, parathyroid, and pancreas

559

How do you differentiate between alkaline phosphatase that originates from the bone vs those that originate from other sources (ie placenta, liver, intestines) 

heat denaturation: bone-specific AlkPhos is easily denatured by heat (bone=boil)

560

patient w/ thyroid that has branching papillary structures w/ concentric calcifications (psammoma bodies) w/ ground glass nuclei

papillary thyroid cancer

561

cleft lip and palate, polydactyly, omphalocele

Patau - trisomay 13

562

initial reaction to form heme involves which two substrates

glycine + succinyl CoA 

catalyzed by ALAS to form d-ALA

563

virus that can replicate in the cytoplasm of an enucleated cell

RNA virus (poliovirus, picoRNAviridae)

564

bone changes consistent w/ hyperparathyroidism?

subperiosteal thinning w/ cystic degeneration of cortical, aka compact, bone (due to PTH-mediated osteoclast activation and resorption

565

amastigote

Leishmania

566

how does TB develop resistance to isoniazid?

  • decr. expression of catalase-peroxidase enz (required for isoniazid activation)
  • modification of the protein target binding site 

567

mother also likely experienced increased facial hair growth and some voice deepening during pregnancy should make you think of...

  • aromatase deficiency - inability to convert androgens to estrogens in the gonads and peripheral tissues; infants should:
    • have high levels of T/androstenedione, since they're not converted to estradiol or estrone, respectively
    • F: 
      ambigious or male-type genitaliaa, 1˚ amenorrhea + tall stature (E is impt for epiphyseal closure)
    • M: tall stature + osteoporosis 
  • This hormonal imbalance can cause virilization in the mothers due to transfer of the excess androgens into the maternal circulation

568

why is HPV 16/18 oncogenic?

produce E6/E7

E6 = binds p53

E7 - binds Rb 

569

bilirubin can be conjugated or unconjugated. 

what happens if there are excessive amounts of these? 

Bonus: what D/O are these present in?

conjugated = water soluble, loosely bound to albumin and excreted in urine when present in excess

  • problems w/ hepatocellular excretion of bilirubin glucuronides into bile canaliculi: Dubin-Johnson (ø), Rotor (low)

unconjugated = water insoluble; tightly bound to albumin and therefore cannot be filtered by the glomerulus and therefore slowly deposits into various tissues, including the brain (-> seizures, neurologic impairment)

  • problems with conjugation of bilirubin glucuronidation: Crigler-Najjar (ø), Gilbert (low)

570

HLA-B27 (+) patient w/ sx suggesting ankylosing spondylitis should be continuously monitored for...

  • enthesitis (inflammation at the insertion sites of tendons into bone)
  • pulmonary/chest expansion - since involvement of the costovertebral + costosternal junctions may cause limited chest movements and resulting hypoventilation
  • ascending aortitis - dilation of aortic ring + aortic regurgitation

571

NT impt for induction of REM sleep

ACh

572

RNA dependent DNA polymerase

what is a form that is present in humans?

aka Reverse Transcriptase 

in humans: Telomerase

573

hypophosphorylated Rb protein does what

prevents G1 -> S transition

allows damaged cells time to repair stuff

574

damage to inferior gluteal n. (L5-S2) can result in what motor deficit?

impaired thigh extension

 this nerve exits the pelvis through the greater sciatic foramen (below the piriformis m.)

575

what should you think of when a MI occurs in the setting of normal coronary arteries?

coronary arteritis

hypercoabulability w/ acute thrombosis

coronary vasospasm 

576

thoracentesis is usually performed between which ribs

5th and 7th ribs along midclavicular line

7th and 9th ribs on the midaxillary line

9th and 11th ribs along the paravertebral line

any higher or lower, there is a risk of injurying the lung or the liver

577

ab with valence of 4

IgA

578

man loses consciousness while buttoning a tight shirt collar. what nerve is stimulated?

CN 9 - buttoning a tight shirt places external pressure on the carotid sinuses, causing the baroreceptors to react as if there is an incrase in systemic BP

Afferent fibers from carotid sinus stretch receptors (Hering's nerv, branch of CN9) sends signals to the NST of the medulla.

 

579

type of hernia that is covered by all 3 layers of spermatic fascia

indirect inguinal hernia; passes laterally to the inferior epigastric a/v

A image thumb
580

what do you expect the testicles of someone with Klinefelter to look like?

hyalinization + fibrosis of the seminiferous tubules + subsequent lack of testosterone synthesis (ie testes are small + firm)

ø T = eunuchoid body habitus (tall, gynecomastia, ø facial/body hair, low muscle mass)

581

how does a femoral hernia occur?

protrudes through the femoral ring, medial to the femoral vessels (NAV-L) and inferior to the inguinal ligament. Patients see a "tender buldge below the inguinal ligament, and just lateral to the pubic tubercle)

common in women

because the femoral canal is small, femoral hernias are prone to incarceration (can't be reduced and cause N/V, abd pain, distension) and/or strangulation (leading to ischemia and necrosis)

A image thumb
582

nitrates have a paradoxical effect - what is it? 

what drugs are effective in preventing this?

nitrates cause arteriolar + venous vasodilation -> decreased BP -> the body senses this and produces a reflex tachycardia via catecholamines, thus increasing mVO2.

prevent by giving ß blockers to slow conduction through AV node and cardiac conduction system by preventing catecholamines from stimulating ß1 receptors

can also use diltiazem or verapamil since they can also slow AV nodal conduction

583

depolarizing neuromuscular junction blockers?

non-depolarizing neuromuscular junction blockers?

what does this all mean?

both can be reversed by:

depolarizing

  • succinylcholine - strong ACh receptor agonist

  • produces sustained depolarization; prevents muscle contraction

  • antidote

    • ​phase I - none

    • phase II - AChEi 

  • ADR: malignant hyperthermia, hyperCa, K

non-depolarizing

  • pancuronium and tubocuarinine - 
    competitive ACh-R antagonist

  • antidote: Neostigmine (AChEi), edrophonium, AChEi

584

Pneumocystis infx + chronic mucocutaneous candidiasis indicates this

underlying T cell deficiency (ie SCID)

585

newborn born at 37wks has puple splotches on the skin, hepatosplenomeagly, and jaundice. CT shows periventricular calcifications. Diagnostic test?

CMV

note that retinal inflammation, sensorineural deafness, and microcephaly are common manifestations

can cause mono-like sx, but the heterophile test is negative (unlike that of EBV)

586

white cottage cheese-like discharge. Culprit?

candida albicans

587

drugs that can cause nephrogenic DI

lithium

demeclocycline (ADH antagonist)

588

how does KI administration prevent thyroid absorption of radioactive iodine isotopes?

competitive inhibition, resulting in less radioactive material entering the thyroid, there therefore reduce the amount of tissue damage

589

kneeling all day is expected to result in...

pre-patellar bursitis "housemaid's knee"

common in roofers, plumbers, and carpet layers

A image thumb
590

prophylaxis for meningococcal meningitis in patients who have come in close contact with a patient with active disease 

Rifampin 

(NOT vaccination)

591

ribavirin

MoA

clinical use?

what is it normally used in conjunction with?

nucleoside analog that inhibits synthesis of guanine nucleotides, thereby intefering w/ the duplication of viral genetic material via several mechanisms

used in chronic HepC (adults) and RSV (viral bronchiolitis in

HepC used in conjunction with IFNa

592

release of thyroid hormone is regulated through (-) feedback inhibition by....

T3 on hypothalamic TRH-secreting neurons and thyrotroph cells of the anterior pituitary

593

why is only physostigmine used to reverse atropine OD while neostigmine and edrophonium, both with the same MoA, are not?

physostigmine is the only one that can cross the BBB to alleviate teh CNS sx (psychosis, delirium)

594

Which pathogens produce factors that inactivate 60S ribosome by removing adenine from the tRNA, thereby preventing binding of tRNA?

Shigella and EHEC 0157:H7

595

You're performing an eye exam on a patient and notice this. What d/o does this patient have?

Q image thumb

NF-1 (von Recklinghausen disease)

these are lisch nodules (iris hamartomas - asymptomatic)

manifests w/ skin nodules (neurofibromas that contain schwann cell proliferations), cafe-au-lait macules, axially freckling

AD - 100% penetrance, variable expression

596

what is PEG used for?

osmotic laxative

others: MgOH, Mg Citrate

597

patient receiving broad-spectrum for extended periods of time are at risk of what and why?

blood in stool because vitamin K is made by bacteria in the gut

c. diff

598

adjustable gastric band (around cardiac part of stomach) must pass through which of the following ligaments?

what is contained within this particular ligament?

lesser omentum - dbl layer of peritoneum that extends from the liver to the lesser curvature of the stomach (divided into hepatogastric + hepatoduodenal ligament)

contains portal triad

599

pathogenesis of ascites in patients with cirrhosis (2)

  1. mechanical compromise of portal vein flow by fibrotic tissue -> increased hydrostatic pressure  
  2. decreased systemic perfusion pressure -> RAAS activation -> avid Na/H2O retention 

therefore the treatment for ascites secondary to cirrhosis is actually furosemide + spironolactone

600

What is the metabolic profile of patients with osteoporosis like for

Ca

PTH

Phosphorus

all normal b/c osteoporosis is generally due to micro-architectural deteriorartion of bone tissue, resulting in decreased bone strength

601

F w/ gray discharge

think bacterial vaginosis due to gardnerella vaginalis, usually has fishy odor + Clue cells (epithelial cells covered w/ garnerella bacteria)

602

what does a persistence of HBsAg and HBeAg over a long window period indicate with low to moderate levels of anti-HBcAg IgG + no detectable anti-HBsAg indicate?

acute hepB that progressed to chronic hepatitis with HIGH infectivity

603

crytococcus primary site of entry

lungs

604

23yoF w/ who developed irregular menses after having normal menses, negative pregnancy test, normal pelvic exam.

What does she have and what test will confirm diagnosis?

anovulation - likely cause of dysfunctional uterine bleeding (due to an interruption of the normal sequence of the follicular and luteal phases of the menstrual cycle)

preogestin challenge - causes breakthrough bleeding and can be used to confirm anovulation

 

605

isolated epithelial cells in crypts with fragmented, hyperchromatic nuclei and small discrete blebs containing both cytoplasm + nuclear fragments

apoptosis

GVHD

menstruation

embryogenesis

606

several episodes of migratory thrombophlebitis involving various sites in both arms + legs should make you think of....

Trousseau sign

(lung adenocarcinoma or pancreatic carcinoma)

 adenocarcinomas produce thromboplastin-like substance that is capable of causing chronic intravascular coagulations that are both disseminated + tend to "migrate" -> produces redness + tenderness on palpation of extremities 

could also be small vessel hypersensitivity type of vasculitis

 

 

607

palpitations that start/stop abruptly

suspicions: abnormal conduction pathway in the patient that bypasses the AV node 

affects which part of the EKG?

Wolf-Parkinson-White

accessory pathway: Bundle of kent - allows recurrent temporary tachyarrhythmias by "pre-exicting" the ventricles ahead of the normal conduction pathway and results in:

  • shortened PR interval
  • delta wave (early upslope of each QRS complex)
  • widened QRS complex - which conversts to a narrow QRS during tachyarrhythmias bc the accessory pathway no longer pre-excites the ventricles, but instead forms a re-entrant circuit back to the atria

608

Which one does this graph represent? (choose one)

Aortic insufficiency

Aortic Stenosis

Mitral Stenosis

Mitral regurgitation

Q image thumb

Mitral Stenosis

609

what should patients be tested for prior to starting methotrexate or leflunomide?

baseline LFTs since hepatoxocity is a major ADR of these agents

610

Interpret this:

HBsAg negative
anti-HBc negative
anti-HBs negative

Susceptible

611

musculocutaneous nerve courses directly between these two muscles

injury to this will result in:

biceps brachii and coracobrachialis

injury: paralysis of biceps + brachialis = inability to flex arm

612

agratroban MoA and use

other Rx in the same class?

inds to thrombin active site directly and inhibits its function

use in treatment of HIT or patients w/ established HIT

other Rx in the same class: hirudin, lepirudin, and agratroban

613

NF-kB stimulates what? 

cytokine production in immune response against infectious pathogens

614

where are ethmoid air cells located?

medial to the orbit

615

Omalizumab 

MoA and use

mAb that prevents IgE binding to mast cells

use: allergen-induced bronchial constriction; uncontrolled severe allergic asthma

616

interpret this

HBsAg positive
anti-HBc positive
IgM anti-HBc positive
anti-HBs negative

Acutely infected

617

∆ btwn Mallory bodies and Councilman bodies?

what do they lookl ike on histology?

Mallory - intracytoplasmic; damaged cytokeratin filaments

Councilman - extracellular; apoptosed (shrunken) hepatocytes

BOTH eosinophilic

618

62F w/ cough, dyspnea + CXR w/ pulmonary infiltrate

Hx shows columnar mucin secreting cells that fill alveolar spaces w/o invasion of stroma or vessels

Bronchioalveolar carcinoma - subtype of lung adenocarcinoma.

arises in the periphery; multifocal

619

what should you suspect if the pH of 7.xx is less than PCO2=xx?

that there is a respiratory failure (or lack of respiratory compensation to some metabolic disease); normally the last two letters should be relatively the same 

620

tat and rev genes

genes required for HIV replication

621

tenderness in anatomic snuff box - why does this usually occur and what should you worry about

Q image thumb

cause: falling on an outstretched hand -> fracture of scaphoid bone

concern: avascular necrosis of the scaphoid bone (due to how the blood supply is oriented 

 

A image thumb
622

median nerve courses between these two muscles in the forearm and in between these two muscles in the arm

denervation results in...

forearm: biceps brachii and brachialis

arm: flexor digitorum superficialis and flexor digitorum profundus

denervation = ape hand deformity" + loss of sensation on the palmar surface of the first 3 1/2 fingers

623

which two drugs has the highest risk of causing drug-induced lupus?

How do you tell that apart from actual SLE?

Procainamide, hydralazine

DIL + SLE both have (+) ANA and (+) anti-histone antibodies

but unlike SLE, anti-dsDNA are not seen in DIL

624

sharp mid-chest pain that increases w/ deep inspirations and decreases when sitting up

what physical findings are associated with this?

acute pericarditis - presence of friction rub

manuevers decrease the pressure on the parietal pericardium

625

eye field looks like this:

where is the lesion?

Q image thumb

partial lesion in the retina, optic disk, optic nerve

 

A

A image thumb
626

trigger words: painless homogenous testicular enlargement 

seminoma - placental ALP

A image thumb
627

patients w/ cirrhosis - what are 3 indicators of poor prognosis?

basically things that measure the liver's functional reserve:

albumin levels

Prothrombin time (PT)

bilirubin levels

628

when ATP attaches to the  sarcomere, _________

if ATP is not available, _____________

when ATP attaches to the  sarcomere, myosin head deatches from the actin filament and then it energies a conformational change in that resets the myosin head to "contract' again the next time it binds to actin

if ATP is not available, the actin/myosin cross-bridge will persist, resulting in rigor mortis

629

muromonab MoA + clinical uses

anti-CD3 mAb that inhibits T cells

treatment of acute rejection in patients w/ kidney, heart, and liver transplant

630

IgG4 antibodies to phospholipase A2

membranous nephropathy

631

T/F cardiac myocytes can divide in response to increased mechanical loads

F - cardiac myocytes are terminally differentiated cells and can no longer divide. They respond to increased mechanical loads by undergoing hypertrophy (increase sarcomere content and volume of individual ventricuar myocyte)

632

eye field looks like this:

where is the lesion?

Q image thumb

R primary visual cortex (occipital lobe); usually due to posterior cerebral artery occlusion; macula spared due to collateral blood flow from the choroid arteries (middle cerebral arteries)

H

A image thumb
633

S-100

marker for melanoma, neural-derived tumors, and astrocytomas

634

drug used to lower intraocular pressure in glaucoma

carbachol 

pilocarpine

635

leucovorin - when is it used?

prevent ADR of MTX

636

prednisone causes an increase in protein synthesis where? why?

LIVER - stimulate gluconeogenesis + glycogenesis (increase reserves in times of stress)

(note that it antagonizes action of insulin in muscle and adipose, thus favoring catabolism in these tissues, which provides substrates for the anabolic reactions in the liver. Results in

- skin thinning

- muscle weakness

- impaired wound healing

- osteoporosis

- immunosuppression

637

how does celiacs lead to rickets or osteomalacia?

How does it affect serum Ca, serum PO4, serum PTH?

atrophic intestinal mucosa -> malabsorption of vitamin D, Ca, PO4 

low vitamin D -> impaired Ca/PO4 absorption from GI, impaired Ca absorption from kidneys, impaired excretion of  PO4

low Ca -> increased PTH

  • net:
    • serum Ca = decreased
    • serum PO4 = decreased
    • serum PTH = increased

638

2 diseases that we've learned of that have strawberry tongues

scarlet fever (pyogenes)

kawasaki disease

also Toxic shock syndrome

639

most likely outcome for HepB infection? HepC?

  • HepB: acute hepatitis w/ complete resolution (>95% of cases)

 

  • HepC: acute hepatitis that develops into stable chronic hepatitis (55-85% of patients)

640

sabouraud's agar is used for..

culturing coccidioides immitis

641

triad of - non-gonococcal urethritis - conjunctivitis - arthritis

reactive arthritis

642

potency of inhaled anesthetic is determined by?

minimum alveolar concentration

potency = 1/mac

the lower the MAC, the more potent the anesthetic

643

common side effect of HIV protease inhibitors

  • lipodystrophy - fat redistribution from extremities to the trunk
  • hyperglycemia, hyperlipidemia, and hyperinsulinemia (likely due to impair hepatic chyloµ uptake and Tg clearance)
  • nephropathy
  • hematuria (indinavir)

A image thumb
644

best treatment for

  • vascular diseases (coronary, peripheral, and cerebrovascular disease)
  • percutaneous coronary intervention (PCI)
  • treatment of unstable angina and non-Q wave MI

clopidogrel - inhibits ADP mediated platelet aggregation

645

cryptorchidism - how does it affect

sperm count

FSH

LH

inhibin

Testosterone

cryptorchidism (undescended testes) - if not surgically moved to the scrotal sac, the seminiferous tubules can become atrophic/hyalinized over time, resulting in:

sperm count - decrease

FSH - increase (loss of neg. inhibition by inhibin)

LH - normal

inhibin - decrease (due to eventual loss Sertoli cells)

Testosterone - normal

646

pheochromocytoma treatment

alpha blocker (phenoxybenzamine) BEFORE ß blocker to avoid HTN crisis

647

on a cellular level, how does hepB virus cause hepatitis?

presence of viral HBsAg and HBcAg on the cell surface stimulates the host cytotoxic CD8+ T cells to destroy infected hepatocytes

648

Based on the RFLP, at which stage did the non-disjunction occur?

Maternal meiosis I 

Maternal meiosis II

Paternal meiosis I 

Paternal meiosis II

Q image thumb

Paternal Meiosis I

upper band = mother

middle + lower bands = father

A image thumb
649

treatment for nephrogenic DI

HCTZ

indomethacin

amiloride

hydration duh...

650

PKU - what a..a becomes essential?

tyrosine (since it can no longer be synthesized from phenyalanine)

651

IL-10 function

anti-inflammatory function by limiting the production of pro-inflammatory cytokines (ie IFNg, IL2, IL3, TNFa)

produced by macrophages and Th2 cells

652

what exits the jugular foramen?

IX, X, XI, jugular v.

653

dead pt w/ alveolar cells containing golden cytoplasmic granules that turn dark with Prussian blue staining

granules can be lipofuscin or hemosiderin, but prussian blue stain indicates that it is Fe - hemosiderin.

its presence in lung parenchyma indicates increased intravascular pressure that caused RBC to leak from congested capillaries, phagocytosed by alveolar macrophages and converted into hemosiderin "heart failure cells" - associated w/ chronic L heart failure

654

renal: effect of cholera in the small intestines

massive loss of ISOtonic fluid from the GI - decr. in EC volume without significant effect on the IC volume

655

fracture at the junction of frontal, parietal, temporal, and sphenoid will sever this artery

middle meningeal a. (br of maxillary a.) - can cause an epidural hematoma

site: pterion

A image thumb
656

low-pitched holosystolic murmur best heard at the L sternal border w/ accentuation during the hand-grip exercise

VSD accentuated because it increases afterload, which results in an increased movement of blood from the LV to RV (across the VSD)

657

patient w/ lung transplant complains of fatigue and exertional dyspnea. lung bx shows fibrotic obstruction of terminal bronchioles. Why?

chronic rejection - affects the small bronchioli producing the obstructive lung disease "bronchiolitis obliterans" - lymphocytic inflammation of the bronchiolar walls leads to the development of granulation tissue that is later replaced by connective tissue

658

F w/ purulent discharge

(has been described as white, or yellow-green on Uworld)

N. gonorrhoeae or C. trachomatis

usually accompanied w/ cervicitis, can progress to PID

659

conversion disorder

how does it differ from somatization disorder?

voluntary motor or sensory functions that are unexplained by any medical condition; often precipitated by psychological stressors 

 

somatization = multiple physical complaints before 30yo, including 4 pain sx, 2 GI sx, 1 sexual sx, and 1 pseudoneurological sx

660

pathogenesis + biochemical abnormality in Alzheimers

conversion of ß-amyloid from an a-helical configuration -> ß-sheets, which are less soluble and more prone to aggregating and subsequent formation of extracellular  senile plaques 

decr. ACh in the hippocampus (impt for new memories) + nucleus basalis (impt for memory + cognition) due to deficiency of choline acetyltransferase

 

661

metformin 

MoA

clinical use?

contraindications?

what should patients on metformin be monitored for every year?

clinical use: Type II DM

MoA - increase sensitivity of target tissues to insulin

ADR: GI upset + lactic acidosis 

CI: renal failure or any situtation that my preciptate lactic acidosis:

  • liver dysfunction
  • CHF
  • OHlism
  • sepsis

therefore all patients on metformin are monitored yearly for creatinine

662

what enzyme is responsible for allowing patients with ∆fructokinase to be able to allow dietary fructose to enter the glycolytic pathways?

Hexokinase

A image thumb
663

6 day old infant with (+)HBsAg + HBeAg. 

risk of chronic infection?

viral replication rate?

histologic findings of live injury?

how did this happen?

high, high, mild

vertical transmission occurs via passage of fetus through birth canal or transplacental

mild because the HBV is not inherently cytotoxic and the neonates immune system is still immature. But since they're at risk of chronic dz, they can progress to cirrhosis and/or HCC

664

Which part of the nephron does renal cell carcinoma arise from?

Most common metz site of renal cell carcinoma?

Origin: renal tubular cells 

Metz: lungs

665

LH, FSH, estradiol, and estrone in anorexic women?

ALL LOW

Why?

% body fat decreases --> estrogen low --> cyclic LH surge does not occur --> hypogonadoic amenorrhea 

666

patient with recurrent episodes of SOB + wheezing has a CBC that shows eosinophilia. Best Rx?

atopic (extrinsic allergic asthma) - mediated by LTs and ACh

treat w/ zafirlukast + montekast to reduce LT synthesis by mast cells, eosinophils, and basophils, etc that infiltrate the bronchial mucosa in asthmatics

667

long term OH uses causes what in the CNS

treatment?

downregulaton of GABA receptors

inhibits NMDA receptors, leading to upregulation of these recepotors 

increase NE, 5HT, and DA

all lead to tolerance - which cause withdrawal sx "Delirium tremens" = "shakes"/tremors, autonomic dysfunction, anxiety, agitation

trmt: benzos

668

5yo w/ acute colicky abd. pain + loose stools has ∆ mental status, urinated once in the past 10 hrs and urine was red in color; conjunctival pallor. Dx?

HUS

triad of anemia, thrombocytopenia, acute renal failure

669

T/F - ejection fraction is preserved in diastolic dysfunction.

TRUE because diastolic function is a matter of decreased ventricular compliance rather than impaired myocardial contractility. Therefore EF and LV-EDV is normal but LV-EDP is increased

670

what is CEA level used for?

sensitive indicator of CRC recurrence - measure preop and at regular intervals post-op

CANNOT BE USED TO DIAGNOSE CRC...

duh

671

artificial active immunity vs artificial passive immunity

artificial active - stimulus (vaccination with an antigen) was medically applied

artificial passive - stimulus (vaccination with an antibody) was medically applied

672

oocyte surrounded by several layers of follicular cells with a small antrum

secondary follcile

A image thumb
673

F w/ yellow-green foamy, foul smelling discharge

trichomonas - flagellated protozoan

674

gangciclovir 

clinical use

ADR

CMV-induced retinitis

severe neutropenia

675

ADPKD pt w/ blood in subarachnoid space complains of weakness in in his R arm and leg 5 days after the incident. What would've prevented this?

Ca channel blockers,esp Nimodipine can prevent cerebral vascular spasms following SAH. 

(cerebral vascular spasms occur due to degradation products of blood clots)

676

what causes hypoglycemia in both a diabetic and non-diabetic

exercise

677

anaphylaxis to a particular drug - what is most likely to be elevated in the serum

tryptase - released by mast cell degranulation 

678

woman with nipple inflammation, pigmentation and eczematoid changes are at risk of..?

paget disease - presence of individual adenocarcinoma cells within the squamous epithelium of the skin near the nipple. 

679

respiratory symptoms in an HIV patient

pneumocystis jirovecii (CD4

680

Aa-gradient calculation

Aa = PAO2-PaO2

PAO2 = 150 - (PaCO2/0.8) = (FiO2 * (PB-PH2O)) - PaCO2/R)

PaO2 = usually given

 

 

681

what should you suspect in a smoker w/ chronic bronchitis with recent onset of confusion, high fever, water diarrhea, and a mildly productive cough. Sputum gram stain shows numerous neutrophils but ø bacteria. What test should you perform?

Legionella - GN and facultative intracellular

perform urine antigen test

682

areas of the kidney that is most susceptible to injury in ATN

PCT and LOH

(NOT renal papillae - necrosis in this area is usually associated with DM, analgesic nephropathy, sickle cell disease)

683

pulsus alternans

LV dysfunction - beat to beat variation in the magnitude of pulse pressure in the presence of a regular cardiac rhythm

684

which two drugs are strongly associated with fat-redistribution from the extremities and gluteal region to the abdominal viscera (trunk) and neck (buffalo hump)

glucocorticoids 

HIV - protease inhibitors (-navirs)

685

aortic valve calcifications can be associated with what heart sounds?

mid-systolic click followed by creschendo/decreschendo mumur

S4 - due to chronically elevated LV pressures +/- systemic HTN

686

how does taking NTG help with angina?

ADR?

it acts primarily as a veNodilator (ie decrease in LV volume), causing a decrease in cardiac work and decreasing their symptoms

ADR: throbbin HA + cutaneous flushing (due to vasodilatory properties)

687

mid-humerus fracture can injure which nerve? 

radial n. damage - can result in wrist drop (inability to extend the hand)

688

nevirapine, efavirenz, delaviridine

NNRTI - non-nucleoside RT inhibitors that do not require activation via intracellular phosphorylation

ADR: abrupt flu-like sx, abd pain, jaundice, fever (life-threatening hepatic failure w/ encephalopathy), SJS

689

What is acute calculous cholecystitis?

how does this happen?

how is the diagnosis made?

acute inflammation of the gallbladder

initiated by the obstruction of the gall bladder neck or cystic duct; stones disrupt the protective mucus layer, leaving the epithelium exposed to the detergent action of the bile salts. Prostaglandins released in the GB wall further incite inflammation of the mucosa and deeper tissues, and GB hypomotility ensues

increasing distension + internal pressure within the GB eventually results in ischemia. Bacteria then invades the injured and necrotic tissue, causing an infection

690

What is acute acalculous cholecystitis?

how does this happen?

how is the diagnosis made?

acute inflammation of the gallbladder in the absence of gallstones; common in the hospitalized and severely ill

thought to arise secondary to GB stasis and ischemia, which causes inflammation of and injury to the gallbladder wall

US: signs of acute cholecystitis (edematous and enlarged GB) and no gallstones

691

cause of tenosynovitis and pharyngitis

neisseria gonorrhoeae

692

tongue innervation

sensory

motor

taste

somatic sensations (pain, touch, temperature, pressure)

  • anterior 2/3: CN V3 (lingual branch) 5=S
  • posterior 1/3: CN 9
  • posterior area of the tongue root: CN 10

taste

  • anterior 2/3: CN 7 (chorda tympani) 7=T
  • posterior 1/3: CN 9
  • posterior area of the tongue root: CN 10

motor

  • CN 12 (except palatoglossus m., which is innervated by CN 10)

693

ANP's actions

peripheral vasodilation increased urinary excretion of Na/H2O

694

how does e. coli transfer plasmids from one bacteria to anotehr?

conjugation

occurs via pili (often transfers genes for antibiotic resistance)

695

woman w/ ketosis, hypoglycemia, and increased serum levels of propionic acid. what enzyme is inhibited and what a.a. contributes to this patient's condition?

∆ propionyl CoA carboxylase - converts propionyl CoA -> methylmalonyl CoA

catabolism of isoleucine, leucine valine, threonine, and methionine contributes to this problem

"I Love Vermot Maple Trees"

(underline - branch chain a.a. involved in maple syrup urine disease)

696

endocarditis after prosthetic valve placement

s. epidermidis

697

carbon tetrachloride - what does it do?

toxic substance that causes free radical damage. How?

it gets metabolized by P450 in the liver, resulting in the formation of a free-radical CCL3 which reacts w/ structural lipids of cell membranes (lipid peroxidation) --> fatty change and hepatocyte necrosis 

698

Epileptic patient w/ bipolar d/o complains of a "lump" on her neck; admits to feeling "hot" from time to time. 

PE shows generalized lymphadenopathy.

Rx responsible for this and its MoA, ADR

 

phenytoin - reduces ability of Na channels to recover from inactivation -> increases refractory period, thereby inhibiting neuronal high-frequency firing

ADR: hirsutism, coarsening of facial features, acneiform skin rash, gingival hypertrophy, generalized lymphadenopathy

699

macroorchidism

fragile X

affected individuals also have tall stature, large ears, long face, and mental retardation

A image thumb
700

carcinoid syndrome

labs?

typical presentation?

excess production of 5-hydroxytryptamine

facial flushing, bronchospasm, diarrhea

somatostatin analog (octreotide) or resection

701

bone changes consistent w/ osteoporosis

trabecular thinning w/ fewer interconnections; total bone mass is decreased, normal bone architecture is disrputed

702

box-car shaped bacterium

anthrax

703

tensor veli palitini and stylopharyngeus is derived from

4th pharyngeal arch

704

fragile x syndrome genetic finding

trinucleotide repeats

705

cauda equina syndrome (saddle anesthesia + loss of anal wink) affects which nerve roots

S3, S4 (winks galore)

706

aspirin alternative

clopidogrel - blocks ADP receptors on platelets and is just as efficacious as aspirin in preventing thromboembolic disease

707

T/F PPV and NPV are not influenced by disease prevalence

False. PPV and NPV are influenced by disease prevalence but specificity and sensitivity are not.

708

32yo F w/ hx of osteocarcoma presents w/ malignant breast mass. Family hx is (+) for brain tumors, rhabdomyosarcomas.

This story should make you think of...

Li-Fraumeni syndrome

  • mutation of P53, which makes one genetically predisposed to early development of cancers
  • family hx is usually positive for multiple cancers
  • autosomal dominant inheritance.

709

acute lymphoblastic leukemia translocation

ALL t12;21

∆ = 9 = bALLerina has 9 letters; kids do ballet = kids dz.

710

corynebacterium diphtheriae virulence factor has the same mechanism as..di

c. diphtheriae - diphtheria toxin

pseudomonas aeruginosa - exotoxin A 

both inactivate EF-2 via ribosylation

711

this particular vitamin has been shown the inhibit mycolic acid synthesis in mycobacterial cells

Vitamin B6 - remember that it is chemically related to isoniazid, which functions to inhibit mycolic acid in mycobacterial cells

712

4 tumors associated w/ AFP

HCC

yolk sac tumors

Teratoma

Embryonal carcinoma 

713

30yoM w/ exertional calf pain + painful foot ulcers demonstrates hypersensitivity to intradermally injected tobacco extract.

Dx? 

hx?

sx?

Buerger's dz

hypersensitivity to a component of tobacco smoke

hx: segmental vasculitis extending into contiguous veins and nerves

sx: intermittent claudication + Raynaud's, later: ulceration/gangrene toes, feet, fingers

714

MoA for diazoxide

blocks closure of K channels on pancreatic ß cells --> hyperglycemia (due to ø insulin release)

715

desmopressin

ADH analog - desmopressin treatment for central DI

716

Purpose of liver sulfate conjugation (Phase II)?

metabolic pathway that transforms drugs into more polar drugs that can be excreted (ie phenol + chloramphenicol)

717

difference between theca interna vs theca externa?

interna = cells that convert cholesterol -> T under the influence of LH

externa = connective tissue capsule 

718

two studies - one with a p value of 0.03 and a second study with a p value of 0.07 - what should you conclude about the second p value if no other information is given? bastards....

problem with sample size - if the sample study of the second study is small, then it is underpowered to detect a difference in outcome between HRT treated and untreated patients. 

719

patient w/ hypochromic megaloblastic anemia + very high urine orotic acid secretion

diagnosis?

treatment?

 

orotic aciduria - ∆ in UMPS (orotidine phosphoribosyl transferase and orotidine-5-phosphate decarboxylase)

trmt: uridine (inhibits CPS II)

720

F w/ frothy yellow-green malodorous discharge with reddening of the cervix mucosa. Culprit?

Trichomonas vaginalis - flagellated protozoa w/ corkscrew motility

721

T/F Black females have lower bone densities than caucasian females.

FALSE.

Blacks actually have higher bone densities than caucasian females.

Why do we care? dunnoooo

722

prophylaxis in a pregnant woman patient with HIV 

ADR?

nucleoside analog zidovudine (ZDV, AZT) - inhibits reverse transcriptase (NRTI); lacks 3'OH group, thereby preventing transcription once its incorporated into the chain

ADR: bone marrow toxicity->anemia

723

how do L sided colon cancers present? R sided colon cancers?

  • L side:
    • tend to infiltrate the intestinal wall + encircle the lumen.
    • sx of partial intestinal obstruction. change in stool caliber, constipation, cramping abd. pain, abd distension, nausea, vomiting

 

  • R side:
    • tend to grow as exphytic masses; don't tend to develop intestinal obstruction because the lumen is larger on the R than it is on the L.
    • sx of IDA due to ongoing blood loss (anorexia, malaise, weight loss)

724

which of these drugs would account for these changes?

isoproterenol

atropine

phentolamine

propranolol

atropine

NE

Q image thumb

agonist = NE = raises BP via vasoconstriction. Decreased HR is a compensatory response via baroreceptor reflex.

antagonist = atropine = blocks muscarinic receptors; will HR via M2 receptors in SA node (due to removal of parasympathetic tone) has no effect on BP 

administring NE after atropine will still lead to a1-vasoconstriction (incr. BP), but atropine is still blocking the muscarinic receptors in the SA node when NE is administered, therefore NE actions on ß1 receptors on the SA node act to increase HR.

isoproterenol = ß agonist - would decrease in BP via vasodilation

phentolamine = a-antagonist - decreases BP by blocking sympathetic tone  to arterioles.

Propranolol = ß antagonist - small decrease in BP and decrease in HR

FYI - when looking at drug traces, always look at BP first, then HR second since BP will be due to a direct effect on blood vessels and and changes in HR may be due to either a baroreceptor effect or direct effect on the heart. 

725

3 ß blockers w/ intrinsic sympathomimetic activity 

in what patient population are they contraindicated in?

acebutolol

penbutalol

pindolol

that are not recommended for patients w/ angina

726

3 common causes of acute pancreatitis?

labs?

complications?

common causes: gallstone + ethanol + HyperTg

labs: increase amylase, lipase, diffuse fat necrosis + calcium deposits (-> hypocalcemia), fat malabsorption

complications: pancreatic pseudocyst - proteolytic enzymes may disrupt the walls of the pancreatic ducts and cause leakage of the pancreatic secretions into the peripancreatic space --> results in collection of fluid rich in enzymes and inflammatory debris. Walls consist of granulation tissue and fibrosis (not epithelium)

727

common causes of chronic pancreatitis?

labs/findings?

complications?

common causes: ethanol abuse

labs: amylase and lipase may or may not be elevated

findings: atrophied/calcified pancreas

complications: pancreatic insufficiency - steatorrhea, deceased DEAK, DM, pancreatic aenocarcinoma

728

thiamine particpiates in these 4 reactions

transketolase (PPP)

pyruvate DH

a-KG DH (TCA)

a-ketoacid DH (branched chain)

729

faintly erythematous macules on the abdomen, fever, abdominal pain, diarrhea

Tyhoid fever (Salmonella typhi) 

macules are actually called "rose spots"

730

glucocorticoid administration will increase

- which cells in a blood cell count?

- protein synthesis in which organ? 

  • neutrophils - glucocorticoid administration results in demargination of leukocytes previously attached to vessel wall
  • liver - esp enzymes involved in gluconeogenesis + glycogenesis (contributes to the development of hyperglycemia

731

mAb that blocks CD21 on B cells can prevent infection by which virus?

EBV - its glycoprotein binds to the cellular receptor for the C3d complement component (CR2 or CD21). CD21 is present on the surface of B cells AND nasopharyngeal epithelial cells

732

how do these factors change with Hemophiliac A d/o?

Platelet Count

Bleeding time

PT

PTT

clotting factor

Platelet Count = NC

Bleeding time = NORMAL (differentiates it from vWF, which is increased!!)

PT = NC

PTT = increase

Factor 8

*also presents w/ hemoarthroses*

733

osmotic fragility test is used for..?

hereditary spherocytosis 

734

oocytes in ovaries are in which phase of meiosis?

oocytes after ovulation?

oocytes in ovaries = 1˚ oocyte = prophase of meiosis I 

FSH stimulation during ovarian cycle causes some oocytes in the ovaries to complete meiosis I, forming secondary oocytes (+ polar bodies), which begin meiosis II but halts in metaphase.

oocytes after ovulation = 2˚ oocyte = metaphase of meiosis II

remains in this phase until fertilization occurs, at which point it divides into a mature oocyte (+2nd polar body)

735

resting membrane potential is determined by

permeabiilty to K+ via leak channels

736

what do eosinophils produce to help defend against worms?

limit reactions following mast cell degranulation? 

worms defense: major basic protein

limit mast cell degranulation: histaminase and arylsulfatase

737

muscles used when sitting up from supine position sans hands

external abd. obliques

rectus abdominis

hip flexors (iliopsoas)

738

isoniazid

MoA

how does resistance to this drug occur?

clinical use?

  • MoA: pro-drug; requires activation by the mycobacterial catalase-peroxidase before it can inhibit MYCOLIC ACID synthesis
  • Resistance: decreasing the activity of catalase-peroxidase 
  • clinical use: TB

739

2 symptoms that are specific for Graves disease (hyperthyroidism)

 

infiltrative dermopathy (pretibial myxedema/ nonpitting edema) 

ophthalmopathy (proptosis, exophthalmos) - due to lymphocytic infiltrates that that secrete cytokines to stimulate fibroblasts to secrete glycosaminoglycan ground substance (ie hyaluronic acid), which draws water into the orbit resulting in extraocular muscle edema; sensations of grittiness + excess tearing occurs because the lids do not completely cover the prototic globe; can be controlled by high-dose glucocorticoids

both due to autoimmune response directed against thyrotropin receptor that results in accumulation of glycosaminoglycans within the affected tissues

740

MoA of misoprostol

Prostaglandin E1 analog -> uterine contractions + cervical dilation

used as an abortifactant

741

germ tubes should make you think of...

candida albicans 

742

32yoF w/ abnormal uterine bleeding + endometrial hyperplasia + R-adnexal mass. Pregnancy test is negative.

Dx?

Granulosa cell tumor - estrogen-secreting tumor -> endometrial hyperplasia, which can progress to endometrial carcinoma.

(can also cause precocious puberty)

Should see Call-Exener bodies (small follicle-like structures filled w/ eosinophilic secretions)

743

3 Stones that are radiolucent (what does this even mean?!)

how else can they be visualized?

URIC acid (kidney) stones

Brown Pigment Stones (GB stones due to Clonorchis Sinesis)

Cholesterol (Gall bladder) Stones 

cannot be visualized via Xray "radiolucent"

U R Invisible...Be Cool 

visualize via abdominal US or CT 

744

Niacin

MoA

clinical use

ADRs

decrease hepatic VLDL and LDL production and raise HDL.

clinical use: lower TGs to avoid risk of pancreatitis

ADR: flushing (prevent w/ aspirin, since the flushing reaction is partially mediated through prostaglandin synthesis), chemical hepatitis

745

best treatment family members or close contacts of persons w/ meningococcal disease:

vaccine or antibiotics?

prophylaxtic antibiotics - esp. rifampin for Neisseria meningitidis

post-exposure prophylaxis with vaccine is not recommended bc there is no effective vaccine aganist GBS and children

 

746

You're performing an eye exam on your patient and you notice this. 

What d/o does he have?

What is it caused by?

typical findings?

trmt?

 

Q image thumb

Wilson's disease

∆ATP7B = ø Cu excretion into bile (for elimination) = Cu accumulation

Kayser-Fleischer rings (corneal Cu deposits), low ceruloplasmin, Cirrhosis/HCC

basal-ganglia atrophy (parkinsonian-like tremor, asterixis, dyskinesia)

Dementia, Dysarthria

trmt: penicillamine or trientine

747

cardiomeagly + severe generalized hypotonia

hx: abnormal glycogen accumulation in lysosomes

dx?

Pompe disease - ∆ acid maltase (alpha1,4 and alpha1,6 glucosidase activity)

748

What is Osler-Weber-Rendu Syndrome?

typical presentation?

hereditary hemorrhagic telangiectasi - AD inheritance - congenital telangiectasis of skin + mucous membranes

recurrent epistaxis or GI bleeding (melena)

749

MAO-Type B inhibitor

Selegiline

MAO-type B preferentially metabolizes dopamine over NE and 5-HT; inhibition of this results in increased dopamine availability to the brain

ADR: may enhance effects of L-dopa - arrhythmias, dyskinesia/akinesia

750

Rx to prevent perioperative venous thrombosis?

unfractionated heparin or LMWH - increases effect of endogenous anti-thrombin III 

751

what exits the formaen rotundum

v2

752

PECAM1 (CD31)

transmigration into area of injury ("PlEAse-COME" IN)

present on both endothelial cells and leukocytes

 

 

753

cause of acute orchitis in young adults/adolescents? elderly?

young: C. trachomatis, N. gonorrhoeae

elderly: E. coli

754

when necrotic changes are first noticeable in ischemic MI

4-12 hrs

755

what factors act through steroid hormone receptors (cytoplasmic receptors)? 

glucocorticoids

mineralocorticoids

androgens

estrogens

756

a high transepithelial potential difference is usually measured in what d/o? What causes this elevation?

Cystic fibrosis

high transepithelial potential difference (measured in nasal mucosa) is high due to increased Na absorption due to lack of inhibitory effect from the mutated CFTR protein.

757

first symptoms of normal pressure hydrocephalus?

urinary incontinence

ataxic gait

dementia

"wack, wobbly, and wet"

758

Cholestyramine, Colestipol, Colesevelam

Clinical Use

MoA

ADR

What increases ADR?

  • Clinical Use: Elevated cholesterol
  • MoA: bile acid resins that reduce reabsorption of bile acids in the intestines (interferes w/ enterohepatic circulation) ->  hepatic cholesterol is used to resynthesize bile acids -> increases LDL uptake from circulation to do this -> decreases LDL 

  • ADR

    • HyperTg

      • contraindicated in patients with hyper-Tg

    • Cholesterol Gall-stones (esp. when used with gemfibrozil)

    • decrease nutrients/drugs  absorption

      • ​statins must be taken at least 4 hours apart since the bile acid binding resin can impair its  absorption

    • Constipation, bloating

      • CI in patients w/ diverticulosis (constipation worsens the underlying diverticulosis

759

hematogenous osteomyelitis usually occurs where?

metaphysis of long bones - contains slow-flowing sinusoidal vasculature that is conducive to microbial passage

760

among women, name the highest to lowest for:

greatest incidence of cancers 

greatest deaths from cancer

greatest incidence of cancers: breast, lung, colon

greatest deaths from cancer: lung, breast, colon

761

endometrial bx w/ wavy glands w/ subnuclear vacuolization of epithelial cells and stroma that show prominent edema w/ widely separated stromal cells. dx?

asynchronous secretory endometrium - form of dysfunctional ovulatory bleeding that can cause infertility, where the secretory endometrium w/ a mismatch of 2 or more days between glands and stroma

  • wavy glands w/ subnuclear vacuolization of epithelial cells = usually ocur around d17 
  • stroma that show prominent edema w/ widely separated stromal cell = usually occur on d22 

762

impaired tetrahydrobiopterin synthesis affects which neurotransmitters?

NO, Serotonin, Tyrosine, Dopa

"say NO to STDs w/ THB"

763

how does high altitude affect PaO2 and PaCO2?

PaO2 and PaCO2 = both lower than normal due to hypoxemia and resulting hyperventilation and respiratory alkalosis

764

effect of muscarinic agonists on blood vessels

stimulate release of EDRF - endothelium derived relaxation factor

endothelium has receptors for muscarinic receptors --> causes release of NO (aka EDRF) --> increases cGMP --> activates Ca pump to cause Ca efflux --> decrease intracellular conc. --> VSM relaxation

765

newborn w/ hyperphenylalanemia receives tyrosine supplementation and is on a phenylalanine-restricted diet.

Several months later, his serum phenylalanine is normal, but his prolactin levels are elevated.

What is deficient?

dihydrobiopterin reductase - involved in the conversion of

  • phenylalanine -> tyrosine (via phenylalanine hydroxylase)
  • tyrosine -> DOPA (via tyrosine hydroxylase)

∆ dihydrobiopterin reductase -> both rxns are compromised, but since the patient is given tyrosine, only tyrosine -> DOPA is compromised

ø DOPA = ø Dopamine = increased prolactin

 

A image thumb
766

dIgital clubbing is usually associated with these d/o's

any chronic d/o that causes hypoxia

large cell lung cancer, TB, CF, suppurative lung disease (empyema, bronchiectasis, chronic lung abcesss)

767

diagnose

Q image thumb

koilocytes - HPV

768

Which one does this graph represent? (choose one)

Aortic insufficiency

Aortic Stenosis

Mitral Stenosis

Mitral regurgitation

Q image thumb

Aortic Stenosis

769

when is isoniazid monotherapy recommended?

multi-agent therapy?

monotherapy: pts w/ PPD(+) and negative CXR / no evidence of clinical disease

multi-agent therapy: active TB

770

calculation for maintenance dose?

( ( Cp * CL ) / bioavailability fraction ) * # minutes

Cp = steady state plasma conc.
CL = clearance 

net units: mg

for IV Rx, bioavailability fraction = 1

771

HIV ELISA/WB tests in infants

falsely (+) in babies born to HIV+ mothers (anti-gp120 crosses placenta)

772

7yo w/ acute renal failure + bloody diarrhea. Smear shows schistocytes. What is the cause of his anemia?

HUS - likely due to EHEC shiga-like toxin and damaged endothelial cells, which activates platelets and microthrombic formation --> schistocytes. 

BUT coagulation cascade is not activated and therefore PT/PTT is normal in HUS

773

superior laryngeal has an external br. and an internal br. - what do they each innervate?

external br: cricothyroid m.

internal br: sensory innervation above vocal cords

A image thumb
774

treatment for central DI

intranasal DDVAP

hydration duh...

775

16yo boy w/ painless, firm mobile mass beneath the nipple in his L breast. Dx?

gynecomastia

benign proliferation of ductal and stromal elements of the breast; idiopathic condition related to pubertal hormonal changes. 

776

what kind of withdrawal: lack of concentration, HA

caffeine

777

2 anti-hypertensive that causes dyslipidemia

metroprolol

thiazides 

778

inulin purposes

marker of extracellular volume (EC = IS + PV) measure of GFR bc it is freely filtered and not reabsorbed or not secreted

779

treatment of choice for anaphylaxis?

epinephrine - because it can stimulate

  • a1 receptors - counteract the vasodilation of cutaneous + visceral vasculature -> increase BP
  • ß1 receptors - increase cardiac contractility/CO
  • ß2 receptors - bronchodilation (reverse the dyspnea caused by increase in smooth muscle tone in the bronchial wall)

do not use NE - because it has mostly a1 effects and can cause intense vasoconstriction, which may limit CO (since it doesn't really have a big effect on ß1 receptors) and it does not reverse the increased bronchial wall tone)

780

angiogenesis is driven by two factors

VEGF and FGF

 FGF =  fluids grow first

781

How does systolic and diastolic heart differ in terms of ventricular contractile performance?

In each scenario, what must the heart do in order to achieve a near normal stroke volume?

  • Systolic HF (impaired myocardial contractility) - decrease in ventricular contractile performance (decreased EF)
    • requires increased LV-EDP and LV-EDV to improve stroke performance
  • Diastolic HF (decreased ventricular compliance) - decrease in ventricular diastolic compliance but normal ventricular contractile performance
    • LV-EDP must be increased (a->b) in order to achieve a normal LV-EDV and keep CO at baseline

A image thumb
782

what part of the cell cycle does griseofulvin affect? what is this drug usually indicated for?

cell mitosis at metaphase

indicated for dermatophytoses

783

eye field looks like this:

where is the lesion?

Q image thumb

R temporal lobe (Meyers loop)

F

A image thumb
784

stones that form under increased pH

stones that form under decreased pHs

increased pH (basic = phosphate)

  • calcium phosphate
  • ammonium magnesium phosphate 

decreased pH (acidic = OUCH - the H indicates H+!!!)

  • calcium oxalate 
  • uric acid
  • cystine 

785

heart findings in XO patients

coarctation of aorta

bicuspid aortic valve

786

T cell associated with Crohns? UC?

Crohns = Th1

Ulcerative Colitis = Th2 (2 words)

787

lamivudine

MoA

ADR

cytosine (nucleoside) analog RT inhibitor (NTRI) - inhibits HIV RT via chain termination

must be phosphorylated to its active form 

ADR: Lactic acidosis + peripheral neuropathy

788

∆ btwn type I and type II muscle fibers?

Type I = slow twitch 

  • performs actions that require low-level sustained force (ie postural maintenance)
    • ​paraspinal m.
  • aerobic metabolism (high myoglobin + mitochondrial concentrations)

Type II = fast twitch (two-fast)

  • generating rapid forceful pulses of movement
    • latissimus dorsi, pec major, biceps, deltoid
  • anerobic metabolism

789

role of eosinophils in host defense during parasitic infections?

ADCC (when stimulated by IgE bound to a parasitic cell) via major basic protein

Type I HSR

790

genetic abnormality of patient with macular pallor with cherry red dot, no hepatomeagly

Tay sach's - frameshift

791

typical labs in a patient with sickle cell:

haptoglobin

LDH

bilirubin

abnormally low due to sickling + destruction of RBC results in decreased haptoglobin

increased LDH

increased indirect bilirubin

792

Quellung reaction is used to identify what

S. pneumo - capsule swells when specific anti-capsular antibodies are added

793

antibiotic that causes thrombocytopenia, optic neuritis and has a high risk of serotonin syndrome

linezolid - inhibits bacterial protein synthesis by binding to a 50s subunit

794

IL3 function

growth/differentiation of stem cells in bone marrow

795

thickened whitish plaque w/ slightly ulcerated crusted surface

vs

multiple reddish-brown papular lesions on penis

vs

single or multiple red-shiny plaques

Bowen disease - thickened whitish plaque w/ slightly ulcerated crusted surface

Bowenoid papulosis - multiple reddish-brown papular lesions on penis

Erythroplasia of Queyrat - single or multiple red-shiny plaques

 

A. Bowen B, Erythroplasia of Queyrat. C, Bowenoid papulosis.

A image thumb
796

cause of pharyngitis and glomerulonephritis

streptococcus

797

what will decrease the effects of Iodide that is used to treat hyperthyroisim?

perchlorate and pertechnetate - both are taken up by the thyroid via same mechanism that is used to transport iodide "competitive inhibition"

798

chemoRx associated w/ dry cough and exertional dyspnea

Bleomycin 

799

Holiday heart syndrome

binge OH consumption that results in a-fib - irregularly irregular series of QRS complexes and absent P waves

800

What is this and what is it caused by?

aspiration of this puts the patient at risk of?

What do surgeons do to prevent this? 2

Q image thumb

liver hydatid cyst; commonly caused by ingestion of Echinococcus granulosus eggs from dog feces...

can cause anaphylaxis if antigens are released

prevent by pre-injecting ethanol to kill cysts and treating with albendazole

801

thyroidectomy can injure these particular nerve branches w/ respect to specific arteries

recurrent laryngeal n. = inferior thyroid a.

external br. of superior laryngeal n. = superior thyroid a.

802

70M elevated Alk Phos + haphazardly-oriented cement lines that create a pattern of lamellar bone

cell type involved in the initial lesion?

Paget's disease

osteoClasts

 

803

how does a defect in sertoli cells affect LH and testosterone?

defect in leydeg cells?

defect in sertoli cells -> decreased inhibin + spermatogenesis -> increased FSH but normal LH/Testosterone (since inhibin only feedsback to FSH)

defect in leydig cells -> increased GnRH (since there's no negative feedback) -> increased LH, FSH,  but decreased testosterone (since there's no leydig conversion of cholesterol -> testosterone) 

804

hepatic adenomas are usually caused by?

how do you treat them?

typically found in patients w/ a long hx of OC or anabolic steroid use

trmt: stop OC...duh

805

drug that prolong QT but does not predispose to torsades

amiodarone - via K-mediated repolarization on myocardial cells

806

losartan does what to

  • arterial pressure
  • TPR
  • Na excretion
  • Aldosterone levels

arterial pressure - decr

TPR - decr

Na excretion - incr

Aldosterone levels - decr

807

a positive Rinne test is considered..

NORMAL - if the sound is best heard at the EAM (compared to the mastoid; ie air counducted sound is normally louder and heard longer than bone-conducted sound)

(a negative Rinne test is abnormal if the patient hears the vibration better at the mastoid)

808

verapamil should not be prescribed to patients with...

heart failure because the (-) ionotropic effects- causes AV nodal block - of the Rx leads to a decrease in teh force/velocity of myocardial contraction, thereby exacerbating the patient's heart failure

 

also causes constipation and gingival hyperplasia

809

typical anti-psychotic side effects

EPS

  • akathisia - subjective restlessness, inability to sit still; may pace frequently or demonstrate other restless behaviors 
  • acute dystonia - sudden onset, sustained muscle contractions
  • drug-induced parkinsonism - tremor, rigidity, bradykinesia

Tardive dyskinesia

NMS

810

bone changes consistent w/ Paget's disease of the bone

mosaic pattern of lamellar bone w/ irregular sections of lamellar bone; linked by cement lines (represent previous areas of bone resorption)

811

Indinavir

Clinical Use

ADR

Protease inhibitor (enz. requierd for the final step of HIV replication)

  • general ADR
    • Lipodystrophy - increased fat deposition on the back and abdomen "buffalo humb" with decreased adipose adipose tissue on the extremities "peripheral wasting"
    • Hyperglycemia - due to increased insulin resistance
  • nephrolithiasis + hematuria - unique to indinavir

NAVIR Put SUGAR into LIPs - too much can cause kidney failure

812

General ADR of 'navirs

Clinical Use

ADR

Protease inhibitor (enz. requierd for the final step of HIV replication)

  • Lipodystrophy - increased fat deposition on the back and abdomen "buffalo humb" with decreased adipose adipose tissue on the extremities "peripheral wasting"
  • Hyperglycemia - due to increased insulin resistance

NAVIR Put SUGAR into LIPs - too much can cause kidney failure

813

during the inflammatory response, a particular enyme is upregulated (that is normally undetectable in most normal tissues). What Rx would bind to this enzyme?

COX2 - inducible enzyme that is normally undetectable in most tissues except in cases of inflammation

bound to it by aspirin

814

16S rRNA - function?

rRNA in the prokaryotic 30S ribosome, contains a sequence that binds the Shine-dalgarno sequence on mRNA, which is impt for initiation of protein translation

815

Interpret this

HBsAg negative

anti-HBc negative
anti-HBs positive

Immune due to hepatitis B vaccination
 

816

location of fatty acyl coa synthetase

outer-mitochondrial matrix

817

patient w/ acute onset of hip/groin pain that is exacerbated by weight bearing; no swelling, erythema, or temperature change to the affected area.

dx?

how to diagnose?

avascular necrosis of the femoral head

use MRI

818

why is it that someone with prolactinoma can develop low bone density?

bc high levels of prolactin suppress GnRH, leading to hypogonadism, anovulation, and amenorrhea

prolonged hypogonadism can cause accelerated bone loss and increase risk of fractures

819

type II non-cytotoxic hypersensitivity

autoantibodies without complement or neutrophil-mediated destruction of the affected tissues (ie Graves, Myasthenia Gravis)

820

how does acute intravascular hemolysis affect these labs:

haptoglobin

total bilirubin

direct bilirubin

haptoglobin = decreased

total bilirubin = high

direct bilirubin = low

821

What does this represent? (choose one)

Increase preload

Increase afterload

Systolic dysfunction

Increased ejection Fraction

Normal Saline Infusion

Q image thumb

Normal Saline Infusion

822

rupture of tympanic membrane causes what type of hearing loss

condutive

823

picorna virus that is acid labile 

rhinovirus

(compare to rhinovirus that is acid-stable and can pass through the stomach to colonize the GI tract)

824

how does exercise affect PaO2 and PaCO2?

normal PaO2 and PaCO2 since there is increased HR, CO, and RR in to balance the increased total O2 consumption and CO2 production

825

lesions of macula are called

scotomas

826

polyvinyl chloride or arsenic exposure causes this tumor to form of CD31 positivity

liver angiosarcoma 

CD31 is an endothelial cell marker

827

F w/ serosanguinous or watery discharge

atrophic vaginitis (post-menopause)

828

Smoking has a lower incidence of fibrocystic breast disease and uterine cancer. Why is that?

smoking has anti-estrogenic effects

829

Ezetimibe

Clinical Use

MoA

ADR

What increases its effects?

  • clinical use: Hyper-LDL – 2nd line
  • MoA: Decrease intestinal absorption of dietary cholesterol + bile acids -> decrease serum LDL (cholesterol) 

    • Additive effects of reducing LDL when used in combination w/ statins

830

recurrent laryngeal nerve of the vague innervates all laryngeal muscles EXCEPT

cricothryoid (innervated by EXTERNAL br. of superior laryngeal n.)

A image thumb
831

patient w/ coronary stent is placed on aspirn + other Rx. What is the risk of this other drug MoA and what are the associated risks?

ticlopidine - blocks ADP receptors

ADR: neutropenia 

832

62yo immigrant from Asia has acute cholecystitis w. numerous dark stones in the gall bladder. Cause?

infection w/ E. coli, Ascaris lumbricoides, or Opisthorchis sinensis

Brown pigment stones usually arise secondary to infection of the biliary tract, which results in ß-glucuronidase release from injured hepatocytes, which hydrolyzes bilirubin glucuronides -> unconjugated bilirubin in bile 

833

typical presentation of glucoagonoma

DM

anemia 

necrolytic erythema

 

glucagonomas are rare pancreatic tumors

834

two factors that stimulate the development of osteoclastic precursors into mature, multinucleated osteoclasts. What is the stimulator of both of these signals?

RANKL and Monocyte-CSF

835

which viruses buds through and acquires the lipid bilayer envelope from the host cell membrane?

most enveloped nucleocapsid viruses

(except the herpesviruses, which bud through and acquire their envelope from the host cell nuclear membrane)

836

patient w/ fever, back pain or flank pain, inguinal mass, and difficulty walking. Currently lying supine with knee bent and resists extension of the leg and thigh, particularly at the hip.

Psoas abscess

  • likely due to hematogenous or lymphatic seeding or spread from an adjacent site.
  • pain exacerbated by movements that cause the psoas to be stretched or extended (ie hip extension)
  • arises from T12-L5 and inserts on the lesser trochanter of the femur via tendon shared with the iliacus muscle; major flexor of the hip.

 

837

resected liver mass with this pattern is diagnostic of what d/o?

Q image thumb

cavernous hemangioma

congenital malformations that enlarge via ectasia (dilation or distension of a tubular structure), resulting in cavernous, blood-filled vascular spaces lined by a single epithelial layer. benign; 30-50yo. 

biopsy is contraindicated due to risk of hemorrhage

838

cisplatin

MoA

ADR - how to prevent?

  • platinium containing compound that exerts its chemotherapeutic effect by forming ROS that can crosslink DNA
  • ADR: nephrotoxicity - acute tubular injury
    • prevent w/ amifostine - free radical scavenging agent that prevents radicals from

839

lymphadenopathy can represent inflammatory changes within the LN (reactive hyperplasia) or malignant transformation. How do you tell which is which?

reactive - benign, reversible enlargement of lymphoid tissue secondary to antigenic stimulus; polyclonal proliferation (many different cell types) within the LN 

malignant - proliferation of malignant lymphocytes; evidence of monoclonality

840

GN spiral shaped bacteria associated with a decreased number of somatostatin producing antral cells. leads to what?

duodenal ulceration

loss of these somatostatin producing antral cells -> high gastrin levels -> increase histamine production -> increase gastric parietal cells to secrete acid

when this very low pH gastric fluid enters the duodenum, it is not adequately neutralized by local bicarb production, which causes duodenal ulceration

841

LT-B4 function

neutrophil chemotaxis to the site of inflammation

842

tiotropium, ipratropium MoA

muscarinic ACh antagonists - causes bronchodilation

useful for COPD, asthma

843

patient w/ thyroid that shows mononuclear parenchymal infiltration w/ well-developed germinal centers. Dx?

sx?

Hashimotos thyroidtis -> hypothyroidism due to presence of anti-thyroid peroxidase antibody

(also note, Hurtle cells are also present)

sx: fatigability, weight gain, constipation, cold intolerance

844

denosumab

mAb that prevents osteoclast activation by binding to RANKL and preventing its interaction with RANK

845

auditory tube

originates from...

shares its embryologic origin with..

originates from 1st pharyngeal pouch 

shares its origin with middle ear epithelium

846

what is asterixis and what patients would you find them in?

flapping tremor of the hand when the wrist is extended - caused by abnormal function of the diencephalic motor centers in the brain as a result of ammonia accumulation in the body (since less is detoxified to urea)

common in patients w/ cirrhosis

847

where are most dietary lipids digested? absorbed?

Digested: duodenum

Absorbed: Jejunum (includes ADEK)

848

match enzymes w/ numbers

carnitine acyltransferase II

Fatty acyl-CoA synthetase 

G6P DH

hexokinase

Pyruvate Kinase

Smooth ER

Citric Acid cycle

Q image thumb

1 = carnitine acyltransferase II

2 = Fatty acyl-CoA synthetase 

3 = G6P DH, hexokinase, Pyruvate Kinase

4 = Smooth ER

5 =  Citric acid cycle

A image thumb
849

patient w/ L sided heart failure develops significant pulmonary arterial HTN. How does this develop?

L side heart failure -> LA pressure rises -> hydrostatic pressures in pulmonary circuit rise -> capillary leak -> pulmonary edema

edema causes collapse + results in decreased ventilation, which in turn, causes hypoxemia. Reactive vasoconstriction occurs to shunt blood toward areas where ventilation is less compromised -> pulmonary arterial HTN 

850

first-line therapy for acute gouty arthritis

high dose NSAIDs

851

varicose veins pathophysiology

incompetent valves

852

most common hepatic lesion?

what does this look like on a CT scan?

metz from a primary tumor (breast, lung, colon) - usually shows multiple hypodense masses in the liver

853

how do these affect DNA?

irradiation

alkylating agents 

UV radation

irradiation: double-strand breaks and ROS formation

alkylating agents: cross-linking

UV radation: thymine dimers

854

dx of patient with

weakness, gait disturbance, diffiulty releasing doorknob/handshake

cataracts, frontal balding, gonadal dystrophy 

myotonic dystrophy - AD w/ anticipation; due to unstable trinucleotide repeats (CTG) that affects muscle maturation

hx: atrophy of muscle fibers, esp. type I 

(compare to duchenne's - necrosis + fibrofatty replacement of muscle fibers)

855

pain purely in the posterior thigh and leg as well as decr. ankle jerk reflex should make you think of..

sciatica - compression of S1 nerve root

856

NE binds these receptors

a1, a2, b1

857

plasma lipoprotein lipase activity after heparin injection is substantially lower than normal. 

what is the heparin challenge?

what does the tests mean?

heparin causes release of endothelium bound lipases, encouraging the clearance of Tgs from circulation

lower-than-normal activity levels of lipoprotein lipase = deficiency = increased serum chyloµ (dietary lipids)

858

How does heroin affect pupil size + RR?

Miosis (smaller)

Respiratory depression

859

bcl-2

follicular lymphoma t14;18

860

what are these cells?

sertoli cells

  • form tight junction  (line = blood testes barrier)
    • below the line = cells start meiosis I
    • above the line (toward lumen) - cells are in prophase of meiosis I 
  • have prominent nucleoli

A image thumb
861

ectopia lentis

buzzword for..

homocystinuria - defect in cystathionine ß synthase deficiency; characterized by ectopia lentis, mental retardation, marfanoid habitus, and osteoporosis

 

862

diagnose

Q image thumb

CMV - owl eye inclusions

863

cytokine produced from tumor that causes cachexia 

TNFa (aka cachectin) - main mediator of paraneoplastic cachexia by suppressing appetite in the hypothalamus

864

rapid correction of hyponatremia results in?

rapid correction of hypernatremia results in?

HypO = central pOntine demyelination

HypER = cERebral edema

865

differential cyanosis (cyanosis of lower extremities, but not of upper body) in a kid should make you think of....

differential cyanosis is the result of reduced arterial saturation in the distal aorta compared to the proximal aorta

most likely cause: PDA (initial L-> R shunting, but over time the resultant pulmonary HTN can cause pulmonary vascular sclerosis, increase PVR, and reversal of shunt flow across the ductus)

866

what drains into the inferior mesenteric nodes?

anything supplied by the inferior mesenteric a.: L colon, sigmoid colon, upper part of rectum)

867

oseltamivir

MoA

neuraminidase inhibitor - prevents release of newly formed influenza A/B virions

868

virilization of genetically female infants w/ normal BP should make you think of...

aromatase deficiency - inability to convert androgens to estrogens in the gonads and peripheral tissues. Infant should have high levels of T/androstenedione.

(mother also likely experienced increased facial hair growth and some voice deepening during pregnancy)

869

cinacalcet

used to treat 2˚ hyperparathyroidism - increases sensitivity of CaSr to Ca

870

Filgrastim - when is it used?

G-CSF - used to stimulate proliferation/differentiation of granulocytes; used to minimize granulocytopenia after myelosuppressive chemoRx

871

which viruses buds through and acquires the lipid bilayer envelope from the host cell nuclear membrane?

all herpes viruses (1-8)

872

how does lactulose work?

acidifies colonic contents, which converts absorbable ammonia into non-absorbable ammonium ion (ammonia trap)

873

unfractionated heparin MoA

binds to thrombin + anti-thrombin to accelerate inactvation of factor Xa

874

how does amitriptyline cause death?

CARDIC death is most common

TCA inhibits fast Na channel conduction in cardiac myocytes and His Purkinje system --> arrhythmias + refractory hypotension

trmt: NaHCO3

875

why is skeletal muscle resistant to the effects of Ca channel blockers (ie verapamil)

bc skeletal muscle does NOT require an influx of extracellular Ca for excitation-contraction coupling whereas cardiac and smooth muscle cells depend on the extracellular Ca entering the cell via VG L-type Ca channels for excitation-contraction coupling.

876

39F w/ palpable nodularity in the R breast. Hx shows ducts distended by pleomorphic cells w/ prominent central necrosis; lesion does not extend beyond the ductal BM

Q image thumb

comedocarcinoma (subtype of DCIS)

877

recent organ transplant recipient develops F, HA, V; lumbar puncture shows CSF pleocytosis and normal CSF glucose concentration. CSF microscopy shows GPR with tumbling motility.

Dx? How was it acquired?

Listeriosis

cause: listeria monocytogenes - facultative intraccellular parasite that grows within macrophages in immunocompromised hosts; able to multiply at 4˚ = acquired by eating contaminated foods (unpasteurized milk/milk products, undercooked meats, unwashed raw veggies)

878

part of the placenta that is derived from maternal origin

decidua basalis

879

follicle that extends through the entire cortex and bulges out at the ovarian surface

Graafian follicle

A image thumb
880

blood vessels most impt for minimizing the decrease in MSFP caused by blood loss?

venules + veins = impt blood reservoir for circulation during blood loss. Sympathetic activation of these vessels cause them to constrict in order to restore blood volume.

881

99mmTc pertechnetate is used to detect what?

presence of gastric mucosa (ie Meckel's diverticulum)

882

primary amenorrhea in a patient w/ fully developed secondary sexual characteristics can be due to

anatomic defect in the genital tract:

imperforate hymen

Mullerian duct abnormalities

883

tumor cell that can appear in different locations (breast, stomach, ovary, colorectal areas, etc) and contains abundant mucin

signet ring cell carcinoma - do not form glands but contains abundant mucin that pushes nuclei to one side

884

S100 immunoreactivity

schwannomas 

melanomas

(both neural crest cell origin)

885

gluteus medius + minimus functions in

hip ABduction

886

test to perform to confirm dx of acromeagly or gigantism

increase IGF1 failure to suppress GH following oral glucose test

887

when is ßhCG levels detectable after fertilization?

8 days post-ovulation (after the blastocyst implants)

888

what is the acoustic reflex?

dampens the effects of loud noise by causing contraction of the stapedius + tensor tympani m., thereby lessening the responsiveness of the ossicles to sound

889

8yo w/ a hx of fever, abd pain, and diarrhea; hx shows that the patient's puppy also had diarrhea 1 week ago. which one is the most likely culprit?

s. aureus

shigella

bacillus cereus

vibrio parahemolyticus

giardia lamblia

campylobacter

campylobacter - only one in the list that can be transitted from domestic animals to humans; occurs via F/O

890

simple partial seizure

description (consciousness, postictal state)?

first line treatment?

one body part is involved, consciousness is intact, ø post-ictal confusion

carbamazepine

891

maculopapular rash on head that progresses down only on the trunk

occipital + post-auricular lymphadenopathy

german measles (rubella)

892

Tetanospasmin MoA

neurotoxin released by c. tetani - causes inhibition of inhibitory interneurons (which use glycine and GABA) in the spinal cord that regulate the firing of primary motoer neurons --> net increased activation of nerves innervating muscles (spasms, spastic paralysis, hyperreflexia)

893

what happens to screening test values when prevalence declines?

sens + specific = unchanged

increase NPV = NPV / (TN+FN)

decrease PPV

894

35yo w/ sickle cell anemia. What pathogens is he most suscetible to? What should he do to prevent his demise?

likely is asplenic - therefore he is at risk of encapsulated organisms (Ie S. pneumo, H. influenza, N. meningitidis) Salmonella is common in osteomyelitis 

therefore patients should get penicillin prophylaxis + pneumococcal

895

what mediates adhesion of cells to the BM and ECM?

binding of integrins to fibronectin, collagen, and laminin

896

Craniopharyngioma

Location

Appearance

Prognosis, presentation

Pituitary (Rathke’s pouch)

Thick brownish fluid that is rich in cholesterol crystals; may have calcifications

Kids, Bitemporal hemianopia

897

how does PE affect PaO2 and PaCO2?

low PaO2 - due to V/Q imbalances (hypoxemia and stimulation of lung vagal irritant receptors causes hyperventilation, resulting in low PaCO2 

898

STEMI in V1, V2 leads

anteroseptal (LAD)

infranodal Mobitz type II second deg or third deg block would be possible

899

what molecules signal through TK receptors

Insulin

Growth factors (EGF, TGFß, PDGF, FGF etc)

all act via MAPK, Ras

900

why is the pO2 in the L atrium lower than that in the pulmonary veins?

admixture of deO2 bronchial blood (from the bronchial v.) that mixes with the oxygenated blood in the pulmonary veins

901

actin/myosin is to __________ as calmodulin and myosin light chain kinase are to _________

actin/myosin is to skeletal muscles as calmodulin and myosin light chain kinase are to smooth muscles

both are contractile elements

902

this is a liver bx. What is the diagnosis and what causes this appearance??

Q image thumb

Hep B infection
notice the eosinophilic ground glass appearance, which is due to HBsAg filling the cytoplasm

903

calculations for

half-life

maintenance dose

loading dose

half-life (hrs) = Vd * 0.7 / CL

a drug is virtually eliminated after 5 half-life intervals; 75% removal = 2 half-life intervals

Maintenance dose: CPss * CL / bioavailability fraction

loading dose = CPss *Vd / bioavailability fraction

VD = volume of distribution 

CL = clearance

CPss = steady state plasma conc.

Bioavailability fraction = 1 if given IV

904

ergonovine test

ergot alkaloid that constricts vascular smooth muscle by stimulating both a-adrenergic and serotonergic receptors in patients with angina, low doses of ergonovine can induce coronary spasms, chest pain, and STElevation

905

why does squatting help in tetralogy of fallot?

increase in systemic vascular pressure (SVP) reduces the amount of R->L shunting through the VSD, thereby increasing pulmonary flow

 

906

cox enzyme responsible for GI ulcers + bleeding 

solution?

COX1 inhibition causes GI ulcers + bleeding

solution - use a COX2 inhibitor 

 

907

Patients receiving kidney transplant usually receives cyclosporine + tacrolimus.

Why? What do these Rx inhibit?

both inhibit calcineurin activation, which is essential to the activation of IL2 (promotes growth and differentiation of T cells)

908

necrotic cell histology

nuclei are washed out, pyknotic (very compact) or fragmented (karyorrhexis) Necrotic = Nucleus

909

target of:

  • enoxaparin
  • unfractionated heparin
  • fondaparinux
  • rivaroxaban
  • apixaban
  • agratroban
  • bivalruin
  • dabigatran

target of:

  • enoxaparin (LMWH) = AT only
    • enoxaparin is an ATypical anticoagulant - it is NOX your typical anticoagulant!! 

 

  • unfractionated heparin = AT + thrombin (factor 2)

 

  • fondaparinux = factor x
  • rivaroxaban = factor x


  • apixaban = factor x





     

rule of thumb - X = factor 10 is involved (except enoxaparin)



  • a
    gratroban = thrombin 



  • bivalruin = thrombin 





  • dabigatran = thrombin
     

910

25yoF w/ erythematous, painful, ulcerated lesions on labia and perineum. 

Rx? MoA?

Acyclovir - inhibits viral DNA polymerase; must e activated by viral TK

911

damage to tibial n. will result in

weakness of inversion and plantarflexion of foot

912

cause of this graph?

Q image thumb

chronic AVM.

evidence:

  • increased CO
  • decreased TPR (increased slope of both cardiac function curve + venous return curve)
  • increased MSFP

(acutely, an AV fistula causes decreased TPR, which results in increased CO and increased VR, but the VR curve does not immediately shift along the x axis - see graph below. Compensatory responses from the sympathetic nervous system and kidneys results in the effects listed above)

A image thumb
913

small cavities in the deep structures of the brain (basal ganglia, posterior limb of internal capsule, pons, and cerebellum) filled with clear fluid are also known as...

what are they usually caused by?

lacunar infarcts 

due to occlusion of small penetrating arteries that supply these structures; common chronic uncontrolled HTN or DM

vessels have lipohyalinosis and microatheromas

914

pathogenesis of CF

∆508 that cause abnormal protein folding and failure of glycosylation -> CFTR is degraded before it reaches the cell surface

915

definitive sign of heart failure and what can be done to accentuate this?

S3 - accentuated by having the patient lie in the L lateral decubitus position and fully exhale

916

patients with DM - type I is more prone to developing what

other autoimmune d/o (ie autoimmune adrenalitis)

917

how does simvastatin and cholestyramine affect hepatic cholesterol synthesis? what if they're used together?

decrease, increase

if used together, then it will result in a net decrease in cholesterol synthesis and plasma LDL (since LDL will be used to resynthesize bile acids)

918

patient who experienced sudden onset of focal numbness + tingling that fully resolved with a non-remarkable medical history other than hypercholesteremia

what Rx to give her?

MoA / ADR?

She had TIA - give low dose aspirin to prevent 1˚ or 2˚ coronary artery events and ischemic strokes

MoA = irreversibly acetylating and inhibiting COX enzymes. at low dose it predominantely affects COX1, whereas at high doses, it inhibits COX1/2.

ADR: GI ulcers

919

hormones produced by pheochromocytoma are derived from which a.a.?

tyrosine!

920

increased appetite, hypersomnia, intense psychomotor retardation, severe depression

patient is undergoing withdrawal of...?

PE findings?

stimulants (cocaine, amphetamines)

PE: none

921

viral Rx that inhibits DNA polymerase AND reverse transcriptase, but does NOT require intracellular activation

Foscarnet - pyrophosphate analog

used to treat

  • acyclovir-resistant herpesvirus
  • ganciclovir-resistant CMV virus
  • advanced AIDS patients

922

ovary eggs are arrested in what phase of the cell cycle?

DIPLOTENE stage of PROPHASE I stage of the FIRST MEIOTIC division 

remains at this stage from before birth until ovulation; 2nd meiotic stage is completed at fertilization 

923

what receptor type is the antagonist directed against

Q image thumb

M2 cholinergic receptors - present on SA node, which acts to decrease HR

Blocking the M2 receptors on the SA node removes the parasympathetic tone --> increase HR

(note that during the carotid occlusion, there is less stretch of the carotid baroreceptors and less afferent nerve activity is sent to the medulla by CN9; ie carotid occlusion tricks the body into thinking that it has a lower BP than ita ctually has)

924

folic acid is impt in in generating which two factors?

deficiency can result in?

thymidine (dTMP) synthesis (via thymidylate synthetase)

conversion Homocysteine -> methionine 

∆ = megaloblastic anemia + hypersegmented PMNs

925

cross-sectional study

data from a group of ppl to ASSESS FREQUENCY

926

what innervates the submandibular and sublingual gland?

CN 7 

927

thymus

originates from...

shares its embryologic origin with..

originates from 3rd pharyngeal pouch 

shares its origin with the inferior parathyroid glands

928

atrial septal defects are common in..

down syndrome patients

(these patients also have VSD)

929

tumors in the lung apices are also known as

what can they cause?

pancoast tumors - often form in the superior sulcus (groove of subclavian vessels) can cause

  • ipsilateral horner syndrome (ispi ptosis, miosis, anhydrosis)
  • edema of upper extremity (compression of subclavian vessels) 
  • rib destruction
  • atrophy of hands muscles
  • pain in the distribution of C8, T1, and T2 nerve roots (pain in shoulder that radiates towards axialla and scapula)

930

hydralazine

MoA

ADR?

selective arteriolar vasodilation

reduces MAP -> causes reflex sympathetic activation, leading to:

1) increased HR, contractility

2) increased renin activity -> Na/H2O retention

931

bony changes consistent w/ osteopetrosis

marble bone disease (decreased osteoClastic resorption)

persistence of primary, unmineralized spongiosa in medullary canals (in normal individual, bone marrow replaces the primary spongiosa)

932

ETEC - mechanism of disease

Heat-labile (LT) and heat-stable (ST) enterotoxins 

LT is very similiar to cholera toxin in that it increases intracellular cAMP in gut mucosal cells by activating the Gs membrane, thus activating adenylate cyclase

ST - increass cGMP

both result in fluid/electrolyte loss /watery diarrhea

NOT due to endotoxin release, which is LPS. REMEMBER THIS!!!

933

24yo patient w/ ulcerated, painful lesion on precpuce and unilateral inguinal adenopathy

Culprit?

Haemophilus ducreyi - pleomorphic GNR that displays a characteristic "school of fish" pattern on gram stains (parallel short chains)

same growth conditions as H. influenza

934

amassed actin-containing fibroblasts and increased MMP activity after a skin laceration indicates...

actin containing fibroblasts = MYOfibroblasts

fxn: wound contraction

MMPs is not only involved in scar tissue remodeling, but also encourages myofibroblast accumulation at the wound  edges, which would initiate wound contraction during healing by second intention

935

patients on diazepam should avoid what drugs?

drugs that cause sedation:

1st gen anti-histamines: chlorpheniramine, diphenhydramine, promethazine, hydroxyzine 

936

what are choledochal cysts ?

congenital dilation of the common bile duct

937

mediastinal widening on CXR

anthrax; max spore production occurs during stationary phase

938

GABA is derived from which a.a.?

glutamate

939

MoA + 2 major ADR of valproic acid

suppresses abnormal electrical activity in the cortex by affecting GABA and NMDA receptors, as well as Na/K channels

severe hepatotoxicity (measure LFTs)

neural tube defects (spina bifida)

940

enzyme affected by citrate

PFK-1

citrate is produced by citrate synthase from acetyl coA and oxaloacetate, when the CAC slows down, citrate accumulates and acts as a negative allosteric regulator of PFK1 (catalyzes committed step of glycolysis)

941

Enoxaparin MoA

LMWH that binds to anti-thrombin only to accelerate inactivation of factor Xa

942

kuassmaul sign 

paradoxical rise in JVP with inspiration - occurs because the volume restricted RV is unable to accomodate the inspiratory increase in VR 

occurs in patients w/ constrictive pericarditis (thick fibrous tissue in the pericardial space that restricts venticular filling - increases JVP, low CO, and RHF that is resistant to medications)

943

where is folate absorbed

jejunum

(even though it's not really a fat-soluble vitamin....)

944

cryptorchidism

undescended testes

945

general effects of ß1 blockers

act on ß1 receptors to:

decrease HR

decrease renin release from JG cells 

946

treatment of atropine OD

physostigmine - AChE inhibitor - increases ACh availability to counteract atropine's blockade of muscarinic cholinergic receptors

947

MTX is specific for which part of the cell cycle?

S phase because it prevents the synthesis of purine and thymidylic acid

948

48F received opioid analgesics suddenly feels severe abdominal pain. Why?

it causes contraction of the smooth muscles of the sphincter of oddi, leading to constriction and spasm, which increases pressure in the common bile duct, which increases biliary colic.

949

suspect this if ventricular myocytes express mRNA for ANP

ventricular hypertrophy (results in both MORPHOLOGIC + GENE changes)

950

non-bacterial thrombotic endocarditis (NBTE) causes

vegetations of bland thrombus w/o accompanying inflammation or valvular damage

causes:

  • hypercoagulable states (dissemminated cancer "marantic" endocarditis)
  • endothelial injury

951

histological finding in patients w/ temporal arteritis

focal granulomatous inflammation, esp. of the cranial arteries

952

Right anopia has damage to

R optic nerve - retinal artery/central retinal vein occlusion

953

squamous cell carcinoma lung histology shows

keratin pearls + intracellular bridges

954

surgeon w/ shaky hand was trying to ligate the superior thyroid a. and accidently severed this nerve and its innervation to this muscle

external branch of superior laryngeal nerve

innervation: cricothyroid m.

955

treatment of CAH?

low does exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of the adrenal cortex

956

F w/ white curd-like discharge

candida albicans - yeast forms w/ pseudohyphae

957

Follicular cell lymphoma translocation

follicular t14;18; 4 = “four”llicular

OR

diffuse large b-cell lymphoma t14;18 = 4 words

958

glucagon

MoA

give a scenario in which you would administer this?

  • increases hepatic glycogenolysis AND gluconeogenesis to restore glucose levels, usually within 10-15min of administration
  • stimulates insulin secretion from pancreas

administer to a little old lady who loses consciousness in a supermarket with a blood glucose of 34mg/mL (in a hospital, you'd just give IV glucose)

959

polycythemia can be subdivided into absolute vs relative. What does this mean?

absolute - true increase in RBC mass (likely due to polycythemia (1˚) or hypoxia/EPO tumors (2˚)

relative - normal RBC mass; likely due to excess diuresis or dehydration 

960

how is REM affected in persons with major depressive d/o?

increased REM sleep (even though they complain of insomnia)

decreased REm latency

decreased N3 (deep) sleep

961

pathophysiology of hemochromatosis

complications of this d/o?

why do women tend to present signicantlly later?

AR d/o where HFE protein is NOT expressed on the basolateral surface of intestinal cells (where it normally binds to transferrin receptor and regulates traCopyright (c) USMLEWorld, LLC., Please do not save, print, cut, copy or paste anything while a test is active.nsferrin/Fe complex endocytosis into cells)

øHFE = unregulated uptake of dietary Fe = abnormally high levels of intestinal absorption = mildly elevated LFTs, elevated plasma Fe w. >50% TIBC, elevated serum ferritin

Complications: cirrhosis, HCC 

Women tend to present later due to blood loss during menstruation + pregnancy

962

wide fixed splitting of S2 long-term sequelae if not treated?

ASD - creates a L->R shunt due to high pressures in the LA, resulting in increased blood flow through the pulmonary artery long-term: hypertrophy of the muscular pulmonary arteries to accommodate the extra flow (increased pulmonary vascular resistance, pulm HTN) results in a switch to R->L shunt "Eisenmenger's syndrome"

963

Bombesin

marker for neuroblastoma, small cell carcinoma, gastric carcinoma

964

endocarditis due to s. bovis

colon cancer

965

case fatality rate is calculated as

# of fatal cases / total # of people with the disease

966

difference between omphalocele and gastroschisis

  • omphalocele - protrusion of abdominal contents that is covered by peritoneum
  • gastroschisis - protrusion of abdominal contents that is NOT covered by peritoneum

967

A 30-year-old woman is brought into the emergency room. The patient had been dining in a local restaurant, and while eating dessert she noted the following symptoms. Initially there was a tingling sensation that affected the mouth and lips, but then it spread to the face and neck. Then the tingling spread down the arms and legs to the fingers and toes.

 

Cause?

The rapid onset (~30min) of symptoms, as well as the patient's neurologic deficits, are most consistent paralytic shellfish poisoning. Saxitoxin, with actions similar to those of tetrodotoxin (puffer fish), blocks the opening of VG Na+ channelsRecovery is slow due to the extremely tight binding of the toxin to the Na+ channels; but once dissociated, it can be excreted in the urine.

968

phentolamine

when is it given?

a1 blocking drug - usually leads to vasodilation

usually given to coutneract the NE-mediated vasoconstriction

969

patient w/  R leg numbness lifts R foot higher than he does on the L; R foot slaps to the ground w/ each step. 

PE: unable to evert R foot (keeps foot plantarflexed + inverted)

damaged nerve?

common peroneal n.

paralysis of peroneus longus + brevis (mediates foot eversion)

paralysis of tibialis anterior (mediates dorsiflexion)

paralysis of extrinsic extensors of the toes

loss of sensation to the anterolateral leg

NET: foot drop + high stepping gait

970

patients w/ HTN and dyslipidemia has total occlusion of L main coronary artery + diffuse atherosclerotic disease characterized by intimal thickening + collagen deposition. What cells produce this intimal response?

smooth muscle cells - migrate from the media, across the IEL, into the intima where they proliferate and produce collagen to produce a neointima (in respons eto intimal injury)

971

why is pregnancy an independent risk factor for DVTs?

increased production of clotting factors

decreased fibrinolysis

reduced protein S

pressure of gravid uterus on IVC -> venous stasis

972

∆ btwn cherry hemangioma and strawberry hemangioma?

cherry: adults, #'s often increase and do not regress

strawberry: kids; size often increases, but spontaneously regresses

973

Lead inhibits

ALAD + ferrochetolase

974

2 risk factors for infective endocarditis

prosthetic valves prior valvular inflammation and scarring (FIBRIN deposition allows bacteria to bind to it)...duh

975

why does prolactin cause vaginal dryness and bone fractures?

it inhibits GnRH --> hypogonadism --> anovulation, amenorrhea

low extrogen --> vaginal dryness, low bone density

976

amytriptyline 

ADR

potent anti-cholinergic effects 

(may mimic atropine toxicity - fever, mucosal/axillary dryness, cutaneous flushing, mydriasis, and cycloplegia an delirium)

977

medical student begins to dress and act like an attending physician

identification

978

patient presents w/ difficulty swallowing and this (see pic)

diagnosis + treatment?

Q image thumb

koilonychia (spoon nails) + difficulty swallowing (dysphagia) are specific for IDA - iron deficiency anemia

treatment: Fe prep

979

cleft palate results from

occurs hwen the palatine shelves of the maxillary prominence fails to properly fuse with one another or with the primary palate

A image thumb
980

Tadalafil is indicated for two diseases. What are they?

erectile dysfunction

pulmonary artery HTN

981

Fredreich ataxia chromosome

9p (drawing out 9P looks like a walker)

982

what is myelophthisic anemia?

space-occupying lesion in bone marrow -> pancytopenia

(most common = metz to the bone with associated fibrosis)

983

MTX treatment

causes an accumulation of..

prevents synthesis of..

accumulated substrate: Dihydrofolate polyglutamate

(polyglutamation prevents movement of these substrates out of the cell)

prevents synthesis of: purines + thymidlyate synthesis

984

decreased lung compliance is caused by...3

pulmonary fibrosis

insufficient surfactant

pulmonary edema

985

type II cytotoxic hypersensitivity

autoantibodies that bind to specific tissues or cells and cause destruction (ie rheumatic fever, hemolytic disease of newborn)

986

difference btwn communicating + non-communicating hydrocephalus?

communicating: no obstruction to CSF flow; usually occurs 2˚ to dysfunction or obliteration of subarachnoid villi that is caused by meningeal infections or subarachnoid/IVH. ALL ventricles are enlarged

non-communicating - ventricles above the obstruction are enlraged, those below are normal (usually due to aqueductal stenosis, arnoid chiaris or dandy walker malformations)

987

marker of high infectivity in Hepatitis B? low infectivity?

  • high infectivity = HBeAg  (e for elevated, emergency)
  • low infectivity = anti-HBeAg 

988

Cimetidine

MoA

ADR

MoA: H2 receptor antagonist --> decreass HCl production

ADR: gynecomastia, inhibits P450 and may increase levels of warfarnin, phenytoin, propranolol, metoprolol, quinidine, and theophylline

989

F w/ ambigious genitalia, hypotension, and hyperkalemia

deficient enzyme?

21-hydroxylase deficiency

  • decreases cortisol production
  • decreased mineralocorticoid production -> hypotension+hypokalemia
  • increased androgen production -> F have ambigious genitalia 

990

how does citrate work in treating calcium kidney stones?

citrate = binds to free (ionized) Ca and prevent its precipitation, thereby allowing it to be excreted.

991

where is amyloid (AA) made? AL?

AA = liver

AL = bone marrow (Ig light chains)

992

Niacin

Clinical Use

MoA

ADR

  • clinical use: hyperTg – 2nd line, or low HDL
  • MoA: decrease VLDL + Tg (by suppressing FFA release from peripheral tissues and by decreasing VLDL conversion to LDL), increase HDL

  • ADR:

    • Flushing, itchiness (prevent w/ aspirin)

    • Hepatotoxicity

    • Hyperglycemia (acanthosis nigricans)

    • increase uric acid (gout)

 

993

Clozapine

Clinical use

ADR

helpful in treating NEGATIVE symptoms of schizophrenia

ADR: agranulocytosis and seizures

994

3 drugs that inhibit dihydrofolate reductase

Trimethoprim

MTX

Pyrimethamine

 

TMP

995

intracellular signaling factors for a1, a2, ß1, ß2

a1 = increase IP3 -> vasoconstriction

a2 = decrease cAMP -> decrease NE/insulin release

ß1 = increase cAMP -> increase contractility

ß2 = increase cAMP -> bronchodilation/vasodilation

996

most internal component fo the anterior abdominal wall musculature

transversus abdominis (transversalis)

(lies immediately deep to the internal oblique)

997

which monosaccharide has the highest rate of metabolism in the glycolytic pathway and why?

F-1-P (derived from dietary frutose) is rapidly metabolized because it bypasses PFK-1, the rate limiting enzyme of glycolysis

(other sugars enter glycolysis before this rate limiting step and are therefore metabolized more slowly due to the regulation of PFK-1)

998

what should patients be tested for prior to starting hydroxychloriquine?

baseline + follow-up ophthalmologic exams since it can result in irreversible retinal damage w/ long-term use

999

patients with influenza is at risk for what and why?

What pathogens are most common in this particular illness?

bacterial pneumonia (recurrent fever, dyspnea, and productive cough) because influenza damages the mucociliary clearance mxns of the respiratory epitehlium

S. pneumo > S. aureus, > H. influenza

1000

most specific marker for diagnosing acute hepB infection? 

most specific marker of viral replication/increased infectivity?

IgM anti-HBc - remains elevated during the window period (disappearance of HBsAg and appearance of anti-HBs)

HBeAg = e for emergency!!