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1

Most common cause of neural tube defects

Folate deficiency

2

Most common cause of congenital malformations

Alcohol use

3

Most common cause of mental retardation in US

Fetal Alcohol Syndrome

4

Hyperflexible joints, arachnodactyly, aortic dissection, lens dislocation

Marfan's syndrome (Fibrillin defect)

5

Hereditary nephritis, cataracts, sensorineural hearing loss

Alport syndrome (Collagen IV defect)

6

Blue sclera, bone fractures

Osteogenesis imperfecta (mutation in alpha chain of collagen type I, hydroxylation defect)

7

Antibodies against presynaptic Calcium channels at NMJ

Lambert-Eaton myasthenic syndrome

8

Most common adrenal tumor

Benign, non-functioning adrenal adenoma

9

Most common tumor of adrenal medulla in adults

Pheochromocytoma

10

Most common tumor of adrenal medulla in kids

Neuroblastoma

11

Most common cause of primary hyperaldosteronism

Adrenal adenoma

12

Medical treatment for hyperaldosteronism

Spironolactone, Eplerenone

13

Medical treatment for pheochromocytoma

Phenoxybenzamine (non selective alpha blocker)

14

Pheochromocytoma, medullary thyroid cancer, hyperparathyroidism

MEN2A

15

Pheochromocytoma, medullary thyroid cancer, mucosal neuroma

MEN2B

16

Adrenal disease with skin hyperpigmentation

Primary adrenal insufficiency: Addison's

17

HTN, hypokalemia, metabolic alkalosis

Hyperaldosteronism; Conn's syndrome

18

Painless jaundice

Pancreatic cancer

19

Most common cause of acute pancreatitis

Gallstones and alcohol

20

Most common cause of chronic pancreatitis

Alcohol abuse

21

Severe hyperbilirubinemia in neonate

Crigler-Najjar type I

22

Mild benign hyperbilirubinemia

Gilbert syndrome

23

TG accumulation in hepatocytes

Fatty liver disease

24

Eosinophilic inclusions in cytoplasm of hepatocytes

Mallory bodies

25

Cancer linked closely to cirrhosis

Hepatocellular carcinoma

26

Hepatomegaly, abdominal pain, ascites

Budd Chiari syndrome

27

Green/yellow corneal deposits

Kayser-Fleischer rings (Wilson's disease)

28

Low serum Ceruloplasmin

Wilson disease

29

Cirrhosis, diabetes, hyperpigmentation

Hemochromatosis

30

Anaphylaxis on exposure to blood products with IgA

Selective IgA deficiency

31

Coarse facial features, abscesses, eczema

Hyper IgE syndrome

32

Thrombocytopenia, purpura, infections, eczema

Wiskott Aldrich Syndrome (WATER)

33

Delayed separation of umbilicus

Leukocyte Adhesion Deficiency

34

Neuro defects, partial albinism, recurrent infections

Chediak Higashi syndrome

35

Mucin-Filled cell with a peripheral nucleus

Signet ring cell (seen in gastric adenocarcinoma and lobular carcinoma in situ of breast)

36

Most common type of stomach cancer

Gastric adenocarcinoma

37

Ovarian metastasis from gastric cancer

Krukenburg tumor

38

Gastric ulcerations and high gastrin levels

Zollinger Ellison Syndrome

39

Acute gastric ulcer associated with elevated ICP or head trauma

Cushing ulcer

40

Acute gastric ulcer associated with severe burns

Curling ulcer

41

Retroperitoneal Structures
SAD PUCKER

Suprarenal glands
Aorta and IVC
Duodenum (2nd through 4th parts)
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (thoracic portion)
Rectum

42

What do the following cells secrete?
a. G cells
b. I cells
c. S cells
d. D cells
e. Gastric parietal cells

a. Gastrin
b. CCK
c. Secretin
d. Somatostatin
e. Gastric acid and IF

43

Name of monocytes in other parts of the body
a. blood, alveoli, intestines
b. connective tissue
c. liver
d. kidney
e. brain
f. bone

a. macrophages
b. histiocytes
c. Kupffer cells
d. mesangial cells
e. microglia
f. osteoclasts

44

Obligate anaerobe bacteria lack
a.
b.

a. Catalase
b. Superoxide dismutase

45

Obligate AEROBE bacteria are...

(Naggy Pests Must Breathe)

"Naggy Pests Must Breathe"
Nocardia
Pseudomonas
Mycobacterium tuberculosis
Bacillus

46

What serum antibodies are associated with celiac sprue?

Anti-tissue transglutaminase
Anti-gliadin

47

What organism is associated with Whipple disease?

Tropheryma whipplei (gram positive)

48

Defect in chylomicron exportation

Abetalipoproteinemia

49

Cramping associated with milk products

Lactase deficiency

50

Small intestinal mucosa laden with macrophages in the lamina propria (that are filled with PAS+ granules and rod-shaped bacilli seen by electron microscopy)?

Whipple disease

51

Weight loss, diarrhea, arthritis, fever, adenopathy, hyperpigmentation

Whipple disease

52

Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies

Celiac disease

53

What are the common causes of small bowel obstruction?

A - Adhesions from previous surgeries (75%)
B - Bulge/Hernia (second most common cause)
C - Cancer/Tumors (most commonly metastatic colorectal cancer)

54

What heart defect is associated with chromosome 22q11 deletion?

Tetralogy of Fallot, truncus arteriosus

55

What heart defect is associated with down syndrome?

Endocardial cushion defect, ASD, VSD, AV septal defect

56

What heart defect is associated with congenital rubella?

PDA, pulmonary artery stenosis, septal defect

57

What heart defect is associated with Turner syndrome?

Coarctation, aortic root dilation, bicuspid aortic valve

58

What heart defect is associated with Marfan syndrome?

Aortic insufficiency

59

What drugs are used to treat TB?

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

60

Most abundant bacteria in GI tract

1. Bacteroides fragilis
2. E. coli

61

What is fundamental problem in Hirschsprung Disease?

Neural crest cells fail to migrate to the colon --> missing enteric ganglia//nerve plexuses (Auerbach's and Meissner's plexus)

62

Where in GI tract does endodermal tissue make an abrupt transition to ectoderm?

Pectinate line

63

Most common surgical emergency

Appendicitis

64

Severe RLQ pain with rebound tenderness

McBurney's point seen in Appendicitis

65

What cytokines do TH1 cells make?

IL-2 and IFy

66

What cytokines do TH2 cells make?

IL4, IL5, IL10

67

What five classes of medications are used to treat glaucoma?

alpha agonists
beta blockers
diuretics (acetazolamide, mannitol)
cholinergic agonists
prostaglandins (prostaglandin F2-alpha)

68

What nerve is damaged in wrist drop?

Radial nerve

69

What nerve is damaged in scapular winging?

Long thoracic nerve

70

What nerve is damaged if you are unable to wipe your bottom?

Thoracodorsal nerve

71

What nerve is damaged in loss of forearm pronation?

Median nerve

72

What nerve is damaged in weak external rotation of the arm?

Suprascapular nerve

73

What nerve is damaged in loss of elbow flexion and forearm supination?

Musculocutaneous nerve

74

What nerve is damaged in loss of wrist extension?

Radial nerve

75

Which kind of colonic polyp is considered a precursor for malignancy?

Adenomatous polyps

76

Which colon polyp has most malignant potential?

Villous adenomas

77

What are risk factors for colon cancer?

Adenomatous and serrated polyps, smoking, familial cancer syndromes, IBD, diet of processed meat with low fiber

78

Most common cancer of the appendix

Carcinoid tumor

79

GI hamartomas, hyper pigmentation of the mouth and hands

Peutz-Jeghers syndrome

80

Multiple colon polyps, osteomas, soft tissue tumors

Gardner syndrome

81

"Apple core" lesion on barium enema

Colon cancer

82

What makes Lewy Body Dementia unique?

Visual hallucinations, repeated falls, syncopal episodes

83

Most common cause of acute RLQ pain

Appendicitis

84

Most common cause of acute LLQ pain

Diverticulitis

85

Most common cause of RUQ pain

Cholecystitis

86

Colonoscopy reveals very friable mucosa extending from the rectum to the distal transverse colon

Ulcerative Colitis

87

Most common site of colonic diverticula

Sigmoid colon

88

"String sign" on contrast xray

Crohn's disease

89

"Lead pipe" appearance of colon on contrast x-ray

Ulcerative colitis

90

From what tissue does the spleen arise?
What artery is it supplied by?

Mesoderm
Supplied by foregut (Celiac artery)

91

Common cause of pneumonia in immunocompromised patients

Pneumocystis jiroveci

92

Most common cause of atypical walking pneumonia

Mycoplasma pneumoniae

93

Common cause of pneumonia in alcoholics

Klebsiella pneumoniae (think aspiration)

94

Can cause interstitial pneumonia in bird handlers

Chlamydia psittaci

95

Often cause of pneumonia in person with exposure to bats and bat droppings

Histoplasma

96

Often cause of pneumonia who visited Southern California, New Mexico or West Texas

Coccidioides

97

Pneumonia associated with currant jelly sputum

Klebsiella

98

Causes Q fever

Coxiella burnetii

99

Associated with pneumonia acquired from air conditioners

Legionella pneumophila

100

Most common cause of pneumonia in children 1 year or younger

RSV

101

Most common cause of pneumonia in neonate

Group B Strep or E. Coli

102

Most common cause of pneumonia in children and young adults

Mycoplasma pneumoniae

103

Most common cause of viral pneumonia

RSV

104

Causes wool sorter's disease (life threatening pneumonia)

Bacillus anthracis

105

Common pneumonia in ventilator patients and those with CF

Pseudomonas aeruginosa

106

Pontiac fever

Legionella pneumophila

107

How is hemochromatosis identified on biopsy?

With Prussian blue stain

108

What is the classic triad of hemochromatosis?

Cirrhosis, Diabetes, Hyperpigmentation

109

What causes primary hemochromatosis?

C282Y or H63D mutation on HFE gene
Associated with HLA-A3

110

Treatment for hemochromatosis

Phlebotomy or chelation with deferoxamine/deferasirox/deferiprone

111

What conditions is Primary Biliary Cirrhosis associated with/

CREST, Sjogren syndrome, rheumatoid arthritis and celiac disease

112

What conditions is Primary Sclerosing Cholangitis associated with/

Ulcerative colitis

113

What are the two types of gallstones? Which one is more common? When are each seen?

1. Cholesterol stones (80%); associated with obesity, Crohn disease, advanced age, estrogen therapy, multiparty, rapid weight loss, Native American origin, Clofibrate
2. Pigment stones; seen in patients with chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections, total parenteral nutrition (TPN)

114

What conditions can gallstones cause?

Cholecystitis, ascending cholangitis, acute pancreatitis, bile stasis, biliary colic, fistula between gallbladder and small intestine

115

What is cholecystitis?

Acute or chronic inflammation of gallbladder; usually from cholelithiasis (gallstones)

116

What is Charcot triad of cholangitis?

Jaundice, fever, RUQ pain

117

What is porcelain gallbladder?

It is a calcified gallbladder from chronic cholecystitis that is usually found incidentally on imaging. Causes gallbladder carcinoma.

118

GET SMASHED

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hypertriglyceridemia/Hypercalcemia
ERCP
Drugs

119

Clinical presentation of acute pancreatitis

Epigastric abdominal pain radiating to back, anorexia, nausea, fear of eating, increased lipase (and amylase)

120

Complications of acute pancreatitis

Pancreatic pseudocyst (can rupture and hemorrhage)

121

Chronic pancreatitis presentation

Pancreatic insufficiency --> steatorrhea, fat-soluble vitamin deficiency, diabetes mellitus

122

Marker for pancreatic cancer

CA 19-9

123

Risk factors for pancreatic adenocarcinoma

Tobacco use, Chronic pancreatitis, diabetes, age >50, Jewish and Native American males

124

What is Trousseau syndrome?

Migratory thrombophlebitis (redness and tenderness on palpation of extremities) seen with pancreatic (or GI) malignancy

125

Classic triad of symptoms in MS

Scanning speech, intention tremor, nystagmus

126

Lysosomal storage disorder characterized by accumulation of GM2 ganglioside

Tay-Sach disease

127

Lysosomal storage disorder associated with renal failure

Fabry disease

128

What structures perforate the diaphragm and at what levels?

T8 - IVC
T10 - esophagus, vagus nerve
T12 - aorta, thoracic duct, azygos vein

129

What histological change takes place in esophagus of smoker?

Squamous becoming columnar; metaplasia

130

What ratio in amniotic fluid indicates fetal lung maturity?

Lecithin to Sphingomyelin ratio > 2.0

131

What nerve is at risk of injury with fracture of shaft of humerus?

Radial nerve

132

What nerve is at risk of injury with fracture of surgical neck of humerus?

Axillary nerve

133

What nerve is at risk of fracture with supracondylar humerus fracture?

Median nerve

134

Nerve and artery injured from shaft humerus fracture?

Radial nerve and deep brachial artery injury

135

Tidal volume?

Air that moves into lung with each quiet inspiration

136

Inspiratory reserve volume

Air that can still be breathed in after normal inspiration

137

Expiratory reserve volume

Air that can still be breathed out after normal inspiration

138

Residual volume

Air in lung after maximal expiration; cannot be measured on spirometry

139

Inspiratory capacity

IRV + TV

140

Functional residual capacity

ERV + RV - volume of gas in lungs after normal expiration

141

Vital capacity

TV + IRV + ERV - maximum volume of gas that can be expired after a maximal inspiration

142

Total lung capacity

IRV + TV + ERV + RV - volume of gas present in lungs after maximal inspiration

143

Physiologic dead space equation

Vd = VT x ((PaCO2 - PeCO2)/PaCO2)

144

What happens to intrathoracic volume when a lung collapses?

Increases

145

What can cause pulmonary hypertension?

COPD, sleep apnea, frequent thromboembolism, mitral stenosis, left to right cardiac shunts

146

What gene is mutated in primary hypertension?

BMPR2 gene that normally inhibits vascular smooth muscle proliferation

147

What drugs can treat pulmonary hypertension?

Bosentan/Ambrisentan
Prostaglandin analog (Epoprostenol, iloprost)
Sildenafil
Nifedipine

148

What is the mechanism of Bosentan?

Antagonist at the endothelin 1 receptor that decreases pulmonary vascular resistance

149

What antibodies are specific for SLE?

Anti-dsDNA antibodies
Anti-Smith antibodies

150

What is mechanism of type IV hypersensitivity

T cells are sensitized and bind antigens and release cytokines

151

Treatment for methemoglobinemia

Methylene blue or Vitamin C

152

Which form of hemoglobin has high affinity for oxygen?

R form (relaxed) has high affinity for oxygen
T form (taut) has low affinity for oxygen (Tissues)

153

What substances shift oxygen dissociation curve to right?

CO2, elevated 2,3DPG, acidosis, exercise and increased temperature

154

What immunodeficiency matches the following:
a. neutrophils fail to respond to chemotactic stimuli
b. Adenosine deaminase deficiency
c. Failure of endodermal development
d. Defective tyrosine kinase gene
e. Associated with high levels of IgE

a. Job syndrome (hyper IgE) or leuocyte adhesion deficiency syndrome
b. SCID
c. DiGeorge
d. Bruton agammaglobulinemia
e. Hyper IgE syndrome

155

What bacterial structure has the following functions;
a. mediates adherence of bacteria to the surface of a cell
b. protects against phagocytosis
c. space between the inner and outer cellular membranes in gram - bacteria
d. forms attachment between two bacteria during conjugation
e. genetic material within bacteria that contains genes for antibiotic resistance

a. fimbria or pili
b. capsule
c. periplasm
d. sex pilus (F pilus)
e. plasmid

156

What structures arise from paramesonnephric ducts?

Vagina

157

What's a normal A-a gradient?

10-15mmHg

158

What are causes of high A-a gradient?

high FiO2
Shunting of blood
Pulmonary fibrosis
V/Q mismatch
Advanced age

159

Which neurodegenerative disease fits the following:
a. senile plaques, neurofibrillary tangles
b. presents at birth as "floppy baby"
c. lewy bodies

a. Alzheimer disease
b. Werdnig-Hoffman disease
c. Parkinson's, diffuse lewy body dementia

160

What drugs are composed of antibodies against TNF

Etanercept - not an antibody, TNF inhibitor
Infliximab
Adalimumab

161

What is the eye palsy associated with MS and internuclear ophthalmoplegia?

-On lateral gaze abducting eye has nystagmus, adducting eye is unable to adduct
-Convergence is normal
-Medial rectus palsy only shows up during lateral gaze and not with convergence

162

What is the classic presentation of congenital pyloric stenosis?

Infant, 2-6 weeks of age
First born male
Non-bilious projectile vomiting
Palpable mass in RUQ, olive-like
Hypochloremic metabolic alkalosis

163

How does fetal Hgb differ from adult Hgb?

Adult Hgb has higher affinity for 2,3 DPG
Fetal Hgb has higher affinity for O2

164

EKG changes with MI

ST segment elevation of at least 1 mm in 2 contiguous leads
T wave inversion
New LBBB
New Q waves (at least 1 block wide of 1/3 height of total QRS)

165

What serum lab markers are used to diagnose MI?

Troponin I - after 4 hours
CK-MB - after 6-12 hours

166

What is most common lethal complication of MI?

Arrhythmia

167

Chest pain, pericardial friction rub, persistent fever occurring several weeks after an MI?

Dressler syndrome

168

Which hereditary bilirubinemia:
a. responds to phenobarbital
b. grossly black liver

a. Crigler-Najjar type II or Gilbert syndrome
b. Dubin-Johnson syndrome

169

What is complication of silicosis?

Increases susceptibility to tuberculosis

170

What are pathologic findings of HTN?

Medial hypertrophy, fibrosis of the intimate, arteriosclerosis

171

Where do these spinal tracts cross over?
a. dorsal column
b. lateral corticospinal tracts
c. spinothalamic tract

a. Medulla
b. medullary pyramids
c. anterior white commissure

172

What drugs interact with CYP450?

CRACK AMIGOS
Ciprofloxacin
Ritonavir
Amiodarone
Cimetidine
Ketoconazole
Acute alcohol use
Macrolides
Isoniazid
Grapefruit Juice
Omeprazole
Sulfonamides

173

What is a disulfiram like reaction?

Inhibition of acetaldehyde dehydrogenase --> accumulation of aldehyde
Caused by metronidazole, cephalosporins, 1st generation sulfonylureas

174

What are the signs of Right heart failure?

Lower extremity edema, JVD, hepatosplenomegaly

175

What are signs of left sided Heart failure?

Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea

176

a. What are the symptoms of organophosphate poisoning?
b. What are the symptoms of atropine overdose?

a. diarrhea, urination, miosis, bronchospasm, bradycardia, lacrimation, salivation
b. increased temp, decreased secretions, constipation, cyclopedia, mydriasis, confusion, disorientation

177

Outline pathway that Gq receptor activates PKC

Gq --> Phospholipase C --> cleaves PIP2 into DAG and IP3. DAG activates Protein Kinase C and IP3 causes an increase in calcium to cause smooth muscle contraction

178

With what type of heart defect would increasing afterload be beneficial?

Any right to left shunt; tetralogy of fallot, trunks arteriosus, transposition of the great vessels, Eisenmenger syndrome (squatting down)

179

What medications improve survival in CHF?

ACE inhibitors
ARBs
Aldosterone antagonists
B blockers

180

What medications provide symptomatic relief in CHF but do not improve survival?

Diuretics
Digoxin
Vasodilators

181

What medications are used to treat acute heart failure?

Nitrates, Oxygen, Loop diuretics, Inotropes, Positioning

182

What is the mechanism of action of cardiac glycosides like Digoxin?

It inhibits the Na/K ATPase so that Na can't leave the cell --> this inhibits the Na/Ca exchanger so Calcium isn't leaving the cell and Na isn't entering --> Intracellular Calcium increases and causes more muscle contraction

183

What is a cardiac consequence of Lyme disease? What is the vector of Lyme disease?
What are other complications of Lyme disease?

AV nodal heart block; Caused by Ixodes scapularis
Bell's palsy, arthritis,

184

Which blood pressure drugs are C/I in patients with a sulfa allergy?

Thiazides and loop diuretics

185

Which beta blockers are:
a. B1 (heart) selective
b. non selective (B2 in lungs)

a. Starting with A-M
b. Starting with M-Z
Exceptions are Carvedilol and Labetalol which are both a1 and b1

186

Triad of symptoms for ruptured abdominal aortic aneurysm:

Hypotension, pulsatile abdominal mass, abdominal pain

187

What is the most likely underlying reason for:
a. abdominal aortic aneurysm
b. thoracic aortic aneurysm

a. Atherosclerosis (smoking, old age, men)
b. Cystic medial necrosis (HTN, Marfan's, bicuspid aortic valve, tertiary syphilis)

188

What drugs have the following S/E:
a. Agranulocytosis
b. Osteoporosis
c. Pulmonary fibrosis
d. Gynecomastia
e. Photosensitivity
f. Drug Induced Lupus

a. PPU, Clozapine, Carbamazepine, Colchizine, Methimazole
b. Corticosteroids, Heparin
c. Bleomycin, Busulfan, Amiodarone
d. Spironolactone, Digitalis, Cimetidine, Chronic alcohol, Ketoconazole, Marijuana
e. Sulfonamides, Tetracycline, Amiodarone
f. Sulfonamides, Hydralazine, Isoniazid, Procainamide, Phenytoin

189

What adult structures give rise to the:
a. 3rd aortic arch
b. 4th aortic arch
c. 6th aortic arch

a. Common carotid artery and proximal part of internal carotid
b. Left - arch of adult aorta, Right - proximal part of R subclavian
c. Proximal part of pulmonary arteries and ductus arteriosus

190

What causes edema by increased capillary pressure?

CHF, anything that blocks veins (venous thrombosis, compression of veins)

191

What causes edema by decreased plasma colloid osmotic pressure (decreased plasma proteins)?

Nephrotic syndrome
Liver failure
Protein deficiency

192

What causes edema by increasing capillary permeability?

Infection
Toxins
Burns

193

What causes edema by increased interstitial fluid colloid osmotic pressure?

Lymphatic blockage

194

To which category do each of the following drugs belong:
a. 6-mercaptopurine
b. Celecoxib
c. Carmustine
d. Doxycycline
e. Methotrexate
f. Cimetidine
g. Mefloquine

a. anti-cancer
b. COX2 inhibitor
c. Nitrosourea
d. Tetracycline antibiotic
e. Inhibitor of dihydrofolate reductase
f. H2 blocker
g. Anti-malarial

195

What is the antidote for copper, gold or arsenic?

Penicillamine

196

What is the antidote for gold, arsenic or mercury?

Dimercaprol, Succimer

197

What is the antidote for tPA or streptokinase?

Aminocaproic acid

198

What is the antidote for Digoxin?

Anti-digoxin antibody fragments

199

What does heart sound S3 represent?

You hear it in early diastole during rapid ventricular filling phase; it is associated with INCREASED FILLING PRESSURE - seen in heart failure or mitral regurgitation and more common in dilated ventricles

200

What does heart sound S4 represent?

Heard in late diastole (atrial kick); represents HIGH ATRIAL PRESSURE; associated with ventricular hypertrophy --> left atrium must push against stiff LV wall

201

Why does normal splitting happen?

On inspiration there is a drop in intrathoracic pressure that causes increased venous return --> increased RV filling --> increased RV stroke volume --> increased RV ejection time --> delayed closure of pulmonic valve

202

Why does wide splitting happen?

It is seen in conditions that delay RV emptying (pulmonic stenosis, right bundle branch block). The delay in RV emptying causes delayed pulmonic sound. Exaggeration of normal splitting.

203

What is fixed splitting? In which conditions is it seen?

Seen in ASD --> left to right shunt --> that increases RA and RV volumes --> increased flow through pulmonic valve such that the pulmonic valve closure is greatly delayed REGARDLESS OF BREATH.

204

a. What causes aortic regurgitation?
b. What are clinical signs of aortic regurgitation?

a. aortic root dilation (syphilis or Marfan's), bicuspid aortic valve, endocarditis, rheumatic fever
b. Blowing early diastolic decrescendo murmur; wide pulse pressure, bounding pulses and head-bobbing

205

a. What causes mitral stenosis?
b. What are clinical signs of mitral stenosis?

a. Rheumatic fever, can result in left atrial dilation
b. Follows opening snap (from abrupt half in leaflet motion in diastole)

206

a. What does PDA sound like?

a. Continuous machine-like murmur; loudest at S2

207

What are the diastolic murmurs?

Mitral or Tricuspid stenosis
Aortic or Pulmonic regurgitation

208

What murmurs are heard best in left lateral decubitus position?

Mitral stenosis
Mitral regurgitation
Left-sided S3
Left-sided S4

209

Outline pathway of phenlalanine to NE

Phenylalanine is converted to Tyrosine (by Phenylalanine hydroxylase) which is converted to L-DOPA (by Tyrosine hydroxylase) which is converted to Dopamine (by Dopamine dexarboxylase that requires B6) which is converted to NE and then Epi

210

Five most common causes of aortic stenosis

Bicuspid aortic valve
Senile calcification
Rheumatic heart disease
Unicuspid aortic valve
Syphilis

211

What heart murmur is associated with weak pulses?

Aortic stenosis

212

Crescendo-decrescendo systolic murmur best heart in the 2nd-3rd right interspace close to the sternum

Aortic stenosis

213

Early diastolic decrescendo murmur heart best along the upper left side of the sternum

Pulmonic regurgitation

214

Late diastolic decrescendo murmur heard best along the lower left side of the sternum

Tricuspid stenosis

215

Pansystolic mumur best heard at the apex and often radiates to the left axilla

Mitral regurgitation

216

Late systolic murmur usually preceded by a mid-systolic click

Mitral valve prolapse

217

Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspaces close to the sternum

Pulmonic stenosis

218

Pansystolic mumur best heard along the left lower sternal border and generally radiates to the right lower sternal border

Tricuspid regurgitation or VSD

219

Rumbling late diastolic murmur with an opening snap, heard loudest in the 5th interspace in the midaxillary line

Mitral stenosis

220

Continous machine-like murmur

PDA

221

High-pitched diastolic murmur associated with a widened pulse pressure

Aortic regurgitation

222

A gardener with diarrhea, miosis, urination and bradycardia. What do they have? What is the mechanism of action?

Organophosphate poisoning. Inhibition of acetylcholinesterase --> excess cholinergic stimulation of the muscarinic receptors

223

What is the mechanism of N-acetyl cysteine when given as an antidote for acetaminophen overdose?

It regenerates glutathione.

224

Which phase of the myocardial action potential causes myocardial contraction?

Phase 2; when there is Calcium influx through voltage gated Ca channels balancing K efflux

225

a. Which phase of the pacemaker action potential is responsible for the upstroke?
b. Which ion is responsible?

a. Phase 0 is the upstroke from opening of
b. voltage gated Calcium channels

226

Which ion accounts for automaticity of SA and AV pacemaker action potential?

Slow spontaneous diastolic depolarization as Na conductance increases; when it reaches a threshold the voltage gated Calcium channels open

227

Which phase of the pacemaker action potential determines the heart rate?

Phase 4 (when Na conductance is increasing) in the SA node determines HR

228

What are the four important pharmacokinetic equations?

1. volume of distribution
2. clearance
3. loading dose
4. maintenance dose

229

What G protein class does each receptor stimulate:
a. alpha 1
b. alpha 2
c. beta 1
d. beta 2
e. M1
f. M2
g. M3
h. D2

a. alpha 1 - Gq
b. alpha 2 - Gi
c. beta 1 - Gs
d. beta 2 - Gs
e. M1 - Gq
f. M2 - Gi
g. M3 - Gq
h. Gi

230

What enzyme is inhibited by the drug Fomepizole

Alcohol dehydrogenase; antidote for methanol or ethylene glycol poisoning

231

How do ALL Class I anti-arrhythmias works?

Decrease slope of phase 0 (Na influx, rapid depolarization)

232

What are the:
a. class IA anti-arrhythmics
b. class IB anti-arrhythmics
c. class IC anti-arrhythmics
and what is their effect?

a. Disopyramide, Quinidine, Procainamide (double quarter pounder) increase AP duration and increase ERP and decrease slope of phase 0
b. Mexiletine, Lidocaine (mayo, lettuce, tomato) decrease AP duration and decrease slope of phase 0
c. Flecainide, Propafenone (fries please) prolongs ERP in AV node but no effect on ERP in purkinje and ventricular tissue, decreases slope of phase 0 depolarization

233

What is the mechanism and time frame of acute transplant rejection?

Cytotoxic T cells react to MHC
(Cell mediated)
Weeks following transplant

234

Patient with GI bleeding has buccal pigmentation

Peutz-Jeghers syndrome

235

Which immunosuppressant matches each of the following statements?
a. precursor of 6-mercaptopurine
b. Ab that binds CD3 on T cells
c. Ab that binds IL2 on activated T cells
d. inhibits inosine monophosphate dehydrogenase
e. inhibits calcineurin --> loss of IL2 production --> blockage of T cell differentiation and activation
f. metabolized by Xanthine Oxidase - increasing Allopurinol toxicity

a. Azathioprine
b. Muromonab
c. Daclizumab
d. Myocphenolate mofetil
e. Cyclosporine
f. Azathioprine

236

What are the five 2's of Meckel's diverticulum?

First 2 years of life
Within 2 feet of ileocecal valve
2 inches in size
2 percent of population
2 possible types of tissue - pancreatic and gastric epithelium

237

What is treatment for ZE?

High dose PPIs
Sporadic gastrinoma - surgical resection
Metastatic gastrinoma - Octreotide

238

Transplant patient is on Cyclosporine; needs to take an anti-fungal for Candida infection. Which would cause Cyclosporine toxicity?

Ketoconazole

239

What is hyper pigmented skin finding on face during pregnancy?

Melasma

240

Woman breast feeding develops red mass over breast. What is diagnosis?

Mastitis - caused by Staph aureus.

241

What muscles and nerves are derived from 4th and 6th branchial arches?
a. muscles
b. nerves

a. Cricothyroid, Levator veli palatini
b. Branches of recurrent laryngeal and superior laryngeal (vagus branches)

242

What heart defect is associated with the following:
a. 22q11 deletion
b. congenital rubella
c. Turner's syndrome
d. Marfan syndrome

a. truncus arteriosus, tetralogy of ballot
b. PDA or pulmonary artery stenosis
c. coarctation of the aorta and bicuspid aortic valve
d. aortic insufficiency

243

Which organisms do not take gram stain?

Mycobacterium (high lipid content)
Mycoplasma (no cell wall)
Treponema
Rikettsia (intracellular)
Chlamydia (intracellular)
Legionella (intracellular)

244

What is cause of Duchenne's Muscular Dystrophy

X linked recessive
Deletion of Dystrophin gene

245

Cimetidine - CYP inhibitor or inducer?

CYP450 inhibitor

246

Macrolides - CYP inhibitor or inducer?

Inhibitor

247

Azole antifungals - CYP inhibitor or inducer?

Inhibitor

248

Isoniazid - CYP inhibitor or inducer?

Inhibitor

249

Sulfonamides - CYP inhibitor or inducer?

Inhibitor

250

Grapefruit juice - CYP inhibitor or inducer?

Inhibitor

251

Protease inhibitors - CYP inhibitor or inducer?

Inhibitor

252

Ciprofloxacin - CYP inducer or inhibitor?

Inhibitor

253

Barbiturates - CYP inhibitor or inducer?

Inducer

254

Quinidine - CYP inducer or inhibitor?

Inducer

255

Rifampin - CYP inducer or inhibitor?

Inducer

256

Phenytoin - CYP inducer or inhibitor?

Inducer

257

Griseofulvin - CYP inducer or inhibitor?

Inducer

258

Carbamazepin - CYP inducer or inhibitor?

Inducer

259

Chronic alcohol use - CYP inducer or inhibitor?

Inducer

260

Chronic alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs

CYP Inducers
Chronic alcohol
St. Johns Wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine

261

How does alkalosis affect calcium levels?

Increased pH increases affinity of albumin to bind Ca --> causes hypocalcemia (cramps, pain, paresthesias, carpopedal spasm)

262

Causes of low magnesium

Diarrhea, aminoglycosides, diuretics, alcohol abuse