Step 1 Flashcards Preview

Step 1 > Step 1 > Flashcards

Flashcards in Step 1 Deck (1073):
1

Which class of organisms can Vancomycin treat?

Gram positives only

2

MCC of community-acquired pneumonia

Strep pneumoniae

3

MC gram neg cause of pneumonia in a malnourished, debilitated or alcoholic patient

Klebsiella pneumoniae

4

Agar to grow Neisseria

Thayer-Martin

5

Kimmelstiel Wilson Nodules

Both Type 1 and 2 diabetes causing dense hyaline deposits in glomerulus

6

Conduction velocities from fastest to slowest

Purkinje system
Atrial muscle
Ventricular muscle
AV node
SA node

7

Where is the conduction velocity the slowest?

AV node

8

Bone tumor most often associated with Paget's Disease

Osteosarcoma

9

Gout crystals

Negatively birefringent monosodium urate

10

Most common site of endometriosis

Ovary

11

Chocolate cysts

Old blood from endometriosis in ovaries

12

MOA of oseltamivir

Inhibits the neuraminidases of Influenza A and B and prevents release of the virion

13

Follicular Lymphoma

14;18 translocation causing BCL2 overexpression

14

14;18 translocation

Follicular lymphoma (causes BCL2 overexpression)

15

MOA of physostigmine

AChE inhibitor

16

Acetylcholine stimulates _____ receptors on bronchial smooth muscle.

M3

17

Atropine

Competitive muscarinic receptor antagonist

18

Auer Rods

Azurophilic needle-like cytoplasmic inclusions in AML and APL

19

APL

15;17 translocation of RARalpha (17) and promyelocytic gene (15)

20

15;17 translocation

APL

21

Treatment of APL

All-trans retinoic acid

22

All-trans retinoic acid

Treatment for APL

23

Which cytokine is produced ONLY by lymphocytes?

IL2

24

Cadherins

Bind desmosomes and adherens junctions together

25

Molluscum bodies

Large eosinophilic cytoplasmic inclusions of poxvirus particles in molluscum contagiosum

26

Location of latent VZV

Dorsal root ganglia of cutaneous sensory nerves

27

Sublimation

Mature defense mechanism where a person channels unacceptable thoughts or impulses into socially acceptable behavior

28

Mature defense mechanism where a person channels unacceptable thoughts or impulses into socially acceptable behavior

Sublimation

29

Sildenafil

Phosphodiesterase 5 inhibitor which increases cGMP and causes smooth muscle relaxation of the corpora cavernosa

30

Craniopharyngiomas arise from?

Remnants of Rathke's pouch

31

Schizotypal vs schizoid personality disorder

Schizotypal --> perceptual distortions and eccentric behaviors
Schizoid --> detached, unemotional, prefers to be alone

32

Treatment of herpes encephalitis

IV acyclovir

33

Length of time for schizophreniform disorder

1-6 months

34

Length of time for brief psychotic disorder

Less than 1 month

35

Length of time for schizophrenia

Greater than 6 months

36

Typical culprit for HepA infection in US

Raw or undercooked shellfish

37

Which virus is associated with an aversion to smoking?

HepA

38

Type of receptor of calcium-sensing receptors

Transmembrane GPCR

39

Neprilysin

Metalloprotease that leaves and inactivates BNP, glucagon, oxytocin and bradykinin

40

Hindgut organs

Distal 1/3 transverse colon, descending colon, sigmoid colon, rectum

41

4 locations of varices

Esophagus, rectum, umbilicus, retroperitoneal

42

Diagnosis of stronglyoides

Rhabditiform larvae in stool

43

Treatment of strongyloides

Ivermectin

44

Rhabiditiform larvae in stool

Strongyloides

45

Acute rheumatic fever from what bacteria?

UNTREATED Group A strep pharyngitis

46

Aschoff Body

Interstitial myocardial granuloma in acute rheumatic fever

47

Function of leptin

Decreases food intake

48

Function of neuropeptide Y

Produced in arcuate nucleus of hypothalamus and increases appetite

49

Where are Beta1 receptors located

Cardiac tissue
JGA cells

50

Which type of receptor is Beta1

GPCR (Gs)

51

Atenolol

Selective Beta1 antagonist

52

Dobutamine

Mostly Beta1 agonist

(Some beta2, alpha1 agonism)

53

Chlorthalidone

Thiazide diuretic -- blocks Na/Cl co-transporter in DCT

54

Janeway lesions

Painless, erythematous hemorrhagic macules on palms and soles and indicative of bacterial endocarditis

55

Defective nucleotide excision repair

Xeroderma pigmentosum

56

Defective mismatch repair

HNPCC/Lynch syndrome

57

Mutations in nonhomologous end joining cause 2 diseases

Fanconi anemia
Ataxia telagiectasia

58

Start codon

AUG

59

Anti Smith antibodies

SLE

60

Anti-U1 RNP antibodies

Mixed Connective Tissue Disease

61

DeltaF508 mutation

Deletion in the phenylalanine at the 508 position in the CFTR gene causing abnormal protein folding and failure of glycosylation of the receptor which gets degraded by the proteasome causing CF

62

Function of VitC

Acts as a reducing agent for prolyl and Lysyl hydroxylases so that proline and lysine residues can be hydroxylated during collagen synthesis

63

What 2 vitamins do enteric gut flora produce

VitK
Folate

64

Cause of beri-beri

Thiamine deficiency

65

Thiamine deficiency causes 2 diseases

Beri-beri
Wernicke-Korsakoff Syndrome

66

Tacrolimus

Calcineurin inhibitor leading to decreased production of IL2 and decreased activation of T cells

67

Cyclosporine

Calcineurin inhibitor leading to decreased production of IL2 and decreased activation of T cells

68

Aflatoxin

Byproduct of Aspergillus fungi that can lead to HCC

69

Carotid body vs carotid sinus

Body -- chemoreceptor
Sinus -- baroreceptor

70

Lenticulostriate arteries

Small branches of MCA that supply the basal ganglia and are commonly ruptured in hypertensive vasculopathy

71

The ulnar nerve is a branch of the ______ of the brachial plexus derived from the __________ ventral rami.

Medial cord
C8-T1

72

Guyon's Canal

Fibroosseous tunnel between the hook of the hamate and pisiform bones where the ulnar nerve enters the wrist

73

Which diverticulum is true and false?

True -- Meckel's
False -- Zenker's

74

What causes a Meckel's diverticulum?

Partial failure of the obliteration of the vitelline duct

75

Bacterial infection that smells mouse-like

Pasteurella multocida

76

Treatment of infected dog bite

Amoxicillin-clavulanate

77

Which virus infects B cells and causes immortalization

EBV

78

Monospot Test

Agglutination of horse RBCs when human serum with heterophile IgM antibodies is added

79

Heterophile Antibody Test

Test for EBV

80

What virulence factor impairs phagocytosis

Capsule

81

Function of lipooligosaccharide in Neisseria

Induces cytokine production causing shock

82

What virulence factor facilitates bacterial attachment to epithelium

Pili

83

What age group should receive the meningococcal meningitis vaccine?

11-18

84

What are the 2 types of meningococcal meningitis vaccines

1. Polysaccharide capsular
2. Conjugate --> capsule + diphtheria toxoid

85

Dysregulated cell-mediated immune response to an unknown antigen leading to the formation of granulomas.

Sarcoidosis

86

Which type of T cell and 2 cytokines are important in inducing granuloma formation?

TH1
IL2
IFN-Y

87

IFN-Y

Stimulates macrophages

88

Anti-CCP antibodies

RA

89

Which 2 lab findings are most specific for RA?

RF
Anti-CCP Abs (citrullinated peptides)

90

Anti-centromere Abs

CREST Syndrome

91

Anti-dsDNA Abs

SLE

92

What are rheumatoid factors?

Autoantibodies targeting Fc portion of IgG

93

Antinuclear antibodies

Non-specific finding in most connective tissue disorders

94

Anti-phospholipid Abs

SLE
Antiphospholipid Ab Syndrome

95

Most common STI

HPV

96

Which HPV types cause genital warts?

6, 11

97

Condylomata acuminatum

Skin-colored verrucous warts caused by HPV

98

What is the ONLY part of the respiratory tract covered by stratified squamous epithelium?

True vocal cords

99

Preferred cell type of HPV

Basal epithelial cells of stratified squamous epithelium

100

Action of cephalosporins

Irreversibly binds to PBPs like transpeptidases and prevents cross-linking of peptidoglycans in the cell wall

101

Action of penicillins

Irreversibly binds to PBPs like transpeptidases and prevents cross-linking of peptidoglycans in the cell wall

102

Variant (Printzmetal) angina

Random episodes of rest and nighttime angina with transient ST elevations on EKG

103

Random episodes of rest and nighttime angina with transient ST elevations on EKG

Variant (Printzmetal) angina

104

Dihydroergotamine

Alpha and serotonin agonist
Used to treat migraines

105

Alpha and serotonin agonist
Used to treat migraines

Dihydroergotamine

106

Phentolamine

Non-selective alpha antagonist

107

How does the pupil dilate?

Stimulation of Alpha1 receptors causes pupillary dilator muscle to contract leading to mydriasis

108

What is used to dilate pupils before ophthalmic exams?

Phenylephrine

109

Which 2 adrenergic drugs act to defer premature labor and how?

Ritodrine, terbutaline
B2 agonists

110

Treatment of TCA overdose

NaHCO3 (prevents rapid blockade of fast cardiac Na channels)

111

Dizygotic twins

2 sperm + 2 oocytes
Diamniotic and dichorionic

112

Most common type of monozygotic twins

Monochorionic diamniotic

113

Traztusumab

Monoclonal Ab used in HER2-pos breast cancer that binds to HER2 and prevents activation of downstream tyrosine kinases leading to decreased proliferation and cell death

114

Monoclonal Ab used in HER2-pos breast cancer that binds to HER2 and prevents activation of downstream tyrosine kinases leading to decreased proliferation and cell deathT

Traztuzumab

115

Auspitz Sign

Pinpoint bleeding when scale is removed from a psoriasis plaque

116

Black urine

Alkaptonuria

117

Alkaptonuria

Deficiency in homogentisic acid dioxygenase preventing tyrosine metabolism to fumarate and homogentisic acid accumulation leading to black pigment in urine and joints

118

Deficiency in homogentisic acid dioxygenase preventing tyrosine metabolism to fumarate and homogentisic acid accumulation leading to black pigment in urine and joints

Alkaptonuria

119

Starry sky appearance of glomerulus on immunofluorescence

Post-Strep GN

120

Post Strep GN hypersensitivity

Type III

121

Pulsus paradoxicus

Abnormally exaggerated decrease in systolic BP (>10 mmHg) during inspiration

122

Inspiration causes an _______ in VR

Increase

123

Beck's Triad

JVD + hypotension + diminished heart sounds

Diagnosis for cardiac tamponade

124

JVD + hypotension + diminished heart sounds

Beck's Triad (cardiac tamponade)

125

What happens to venous return and cardiac output during inspiration?

VR increases, CO decreases (thoracic cavity becomes negatively pressured)

126

McArdle Disease

Deficiency in myophosphorylase causing decreased glycogenolysis during exercise

127

Deficiency in myophosphorylase causing decreased glycogenolysis during exercise

McArdle Disease

128

Recommendation for HiB polysaccharide conjugate vaccine

2 months

129

Lymph drainage of testes, scrotum and glans penis

Testes -- para-aortic
Scrotum -- superficial inguinal
Glans penis -- deep inguinal

130

Rhinovirus

Naked positive sense ssRNA

131

Pontiac Fever

Acute, flu-like, self-limited disease caused by Legionella

132

Acute, flu-like, self-limited disease caused by Legionella

Pontiac Fever

133

What organism grows on charcoal yeast agar

Legionella

134

Which organism causing pneumonia can also cause severe hyponatremia?

Legionella

135

Which bacteria synthesizes dextrans from sucrose forming the ability to adhere?

Viridans strep

136

NAVEL

From lat --> medial (contents of the femoral triangle)
Nerve, artery, vein, empty space, lymphatics

137

Where is the femoral artery located in the inguinal region?

Mid-inguinal point (midpoint between pubis symphysis and ASIS)

138

Conn Syndrome

Adrenal adenoma producing aldosterone and causing primary hyperaldosteronism

139

Dofetilide

Class III anti-arrhythmic which blocks K channels

140

Which heart layer is most prone to ischemia?

Subendocardium

141

Which vessel in the body carries the MOST deoxygenated blood?

Coronary sinus

142

Naloxone

Pure opioid receptor antagonist with very high binding affinity for Mu receptors and displaces opioids during overdose

143

Pure opioid receptor antagonist with very high binding affinity for Mu receptors and displaces opioids during overdose

Naloxone

144

Milrinone

Selective PDE3 inhibitor that blocks degradation of cAMP and therefore leads to increased cAMP and Ca+2 to promote contractility and systemic vaso/venodilation to improve cardiac function in heart failure

145

Selective PDE3 inhibitor that blocks degradation of cAMP and therefore leads to increased cAMP and Ca+2 to promote contractility and systemic vaso/venodilation to improve cardiac function in heart failure

Milrinone

146

Positive acidified glycerol lysis test

Hereditary spherocytosis

147

Test for hereditary spherocytosis

Acidified glycerol lysis test

148

The portal triad runs into the liver through the ___________

Hepatoduodenal ligament

149

Pringle Maneuver

Clamping the hepatoduodenal ligament during surgery to identify vascular source of internal bleeding

150

Achondroplasia

AD mutation in FGFR3 inhibiting chondrocyte proliferation

151

AD mutation in FGFR3 inhibiting chondrocyte proliferation

Achondroplasia

152

ADPKD

AD mutation in PKD1 (chrome 16) > PKD2 (chrome 4)

153

AD mutation in PKD1 (chrome 16) > PKD2 (chrome 4)

ADPKD

154

FAP

AD mutation in APC gene on chrome 5q

155

AD mutation in APC gene on chrome 5q

FAP

156

Familial hypercholesterolemia

AD mutation causing defective or absent LDL receptor leading to increased LDL and severe atherosclerosis early

157

AD mutation causing defective or absent LDL receptor leading to increased LDL and severe atherosclerosis early

Familial hypercholesterolemia

158

Hereditary hemorrhagic telagiectasia

AD disorder of blood vessels causing telangiectasias, epistaxsis, skin discolorations, AVMs, GI bleeding and hematuria

159

AD disorder of blood vessels causing telangiectasias, epistaxsis, skin discolorations, AVMs, GI bleeding and hematuria

Hereditary hemorrhagic telangiectasia

160

Hereditary spherocytosis

AD mutation in spectrin and ankyrin

161

AD mutation in spectrin and ankyrin

Hereditary spherocytosis

162

Huntington disease

AD inheritance of CAG repeats on chrome 4

163

AD inheritance of CAG repeats on chrome 4

Huntington's Disease

164

Li Fraumeni Syndrome

AD mutation in TP53 causing multiple malignancies at early age

165

AD mutation in TP53 causing multiple malignancies at early age

Li Fraumeni Syndrome

166

Marfan Syndrome

AD mutation in FBN1 on chrome 15

167

AD mutation in FBN1 on chrome 15

Marfan Syndrome

168

MEN Type 1

AD mutation in MEN1 gene causing decreases menin

169

MEN Type 2A and 2B

AD mutation in RET gene

170

NF 1

AD mutation in NF1 on chrome 17

171

NF 2

AD mutation in NF2 gene on chrome 22

172

Tuberous sclerosis inheritance pattern

AD

173

Von Hippel-Lindau Disease

AD inheritance of VHL gene deletion on chrome 3p

174

Cystic Fibrosis

AR mutation in CFTR on chrome 7

175

X-linked Recessive Disorders --> Oblivious Female Will Often Give Her Boys Her x-Linked Disorders

Ornithine transcarbamylase deficiency, Fabry's Disease, Wiskott-Aldrich Syndrome, Ocular albinism, G6PD deficiency, Hemophilia A and B, Bruton agammaglobulinemia, Hunter Syndrome, Lesch-Nyhan Syndrome, Duchenne/Becker MD

176

Myotonic Dystrophy Type 1

AD inherited disorder of CTG repeats in DMPK gene

177

AD inherited disorder of CTG repeats in DMPK gene

Myotonic Dystrophy Type 1

178

Fragile X Syndrome

X-linked dominant inheritance of a CGG repeat in the FMR1 gene

179

X-linked dominant inheritance of a CGG repeat in the FMR1 gene

Fragile X Syndrome

180

Cri-du-chat syndrome

Deletion of the short arm of chromosome 5

181

Deletion of the short arm of chromosome 5

Cri-du-chat syndrome

182

Williams Syndrome

Deletion of long arm of chromosome 7

183

Deletion of long arm of chromosome 7

Williams Syndrome

184

DiGeorge Syndrome

Deletion of 22q11 causing aberrant development of 3rd and 4th branchial pouches leading to thymus and parathyroid aplasia and cardiac defects

185

Deletion of 22q11 causing aberrant development of 3rd and 4th branchial pouches leading to thymus and parathyroid aplasia and cardiac defects

DiGeorge Syndrome

186

Bitot spots

Spots on conjunctiva due to vit A deficiency

187

Vitamin used to treat measles and AML

Vit A

188

Treatment of APML

All trans retinoic acid

189

MSUD

AR mutation causing defect in branched-chain alpha ketoacid dehydrogenase complex leading to decreased metabolism of branched amino acids (leucine, valine, isoleucine)

190

AR mutation causing defect in branched-chain alpha ketoacid dehydrogenase complex leading to decreased metabolism of branched amino acids (leucine, valine, isoleucine)

MSUD

191

Chromosome with Alzheimer's disease associated genes

Chrome 21

192

Adenosine causes vasodilation or constriction?

Vasodilation

193

Lack of what neuropeptide causes narcolepsy?

Hypocretin (orexin)

194

Hypocretin (orexin)

Decreased in narcolepsy

195

Rett Syndrome

De novo mutation in X-linked MECP2 gene causing regression of development, retardation and hand wringing in young girls 5-18 months

196

De novo mutation in X-linked MECP2 gene causing regression of development, retardation and hand wringing in young girls 5-18 months

Rett Syndrome

197

Which ankle ligaments are more prone to sprain, lateral or medial?

Lateral (they are weaker)

198

VitK is required for which clotting factors

2, 7, 9 and 10

199

Pneumonia causing CXR findings that are much worse than clinical appearance of patient

Mycoplasma pneumoniae

200

Anti-endomysial Ab

Celiac disease

201

Anti-tissue transglutaminase Ab

Celiac disease

202

Angiotensin II causes what to occur in the renal vasculature? What is the effect of ACEIs?

AngII --> efferent arteriole constriction to increase GFR
ACEIs --> efferent arteriole dilation causing decreased GFR

203

17alpha hydroxylase deficiency

Causes DECREASED synthesis of androgens and cortisol but causes INCREASED synthesis of aldosterone

204

What would a CBC show in a patient on corticosteroids?

Increased neutrophil count (from demargination)

205

Which class of drugs will lower LDL levels but can cause a RISE in triglycerides if used as a monotherapy?

Bile acid resins (cholestyramine)

206

Indirect inguinal hernias pass through the __________ and are covered by _____________ and are located _________ to the inferior epigastric blood vessels

Deep inguinal ring
Internal spermatic fascia
Lateral

207

Koilocyte

Sign of HPV

208

Dense irregular cytoplasm, perinuclear halo, enlarged raisinoid nucleus

Koilocyte (HPV)

209

Anti cardiolipin Ab

Antiphospholipid Syndrome

210

Anti beta2glycoprotein1 Antibody

Antiphospholipid Syndrome

211

Which disease can cause false pos results on syphillis tests (RPR and VDRL)

Antiphospholipid Syndrome

212

MSUD treatment includes restricting what and supplementing with what?

Branched chain amino acids (leu, ile, Val)
Thiamine

213

Yeast with single broad based bud

Blastomycosis

214

2nd most common cause of cancer death in women

Breast

215

Most commonly diagnosed malignancy in women in the US

Breast

216

Most common site of breast cancer

Upper outer quadrant

217

Most important early marker of acute hepB infection

HepB surface antigen

218

Which 2 markers correlate with infectivity of HepB

HepB E antigen
HBV DNA

219

Which 2 oral drugs used as diabetes therapy causes the most significant risk of hypoglycemia

Glyburide and glimepiride (long acting sulfonylureas)

220

Continuous murmur

PDA

221

HypoxiC vasoconstriction occurs where

Lungs

222

Curved gram neg rod that moves like a corkscrew

Campylobacter

223

Lipooligosaccharide

Endotoxin on outer membrane of Neisseria that causes septic shock and death

224

Release of LOS in Neisseria infection causes what 4 cytokines to be released

TNFa
IL1B
IL6
IL8

225

Three drugs used in cyanide toxicity

Amyl sodium nitrite
Sodium thiosulfate
Hydroxycobalamin

226

Allopurinol increases toxicity of what drug

Azathioprine

227

Dexrazoxane

Iron chelating agent used to bind free radicals and prevent cardiotoxicity caused by anthracyclines

228

Iron chelating agent used to bind free radicals and prevent cardiotoxicity caused by anthracyclines

Dexrazoxane

229

Unusually high MMPs in a wound can signify

Wound contracture

230

When does development of external genitalia occur?

8-15 weeks

231

Hypospadias develop from incomplete fusion of what?

Urogenital folds

232

What do the urogenital folds become in the female and male?

Labia minora
Fuse in male to become the ventral aspect of the penis

233

Phenoxybenzamine

Irreversible alpha1 and alpha2 antagonist

234

Anti-Histone Ab

Drug-Induced SLE

235

IL10

Anti-inflammatory cytokine that reduces production of pro-inflammatory IL2 and IFNY and inhibits activated DCs and macrophages

236

Anti-inflammatory cytokine that reduces production of pro-inflammatory IL2 and IFNY and inhibits activated DCs and macrophages

IL10

237

India Ink Stain

Cryptococcus neoformans

238

Sabouraud agar

Cryptococcus neoformans

239

Tx of cryptococcus meningitis

Initial --> Amphotericin B + flucytosine
Maintenance --> Fluconazole

240

In general, most enzyme deficiencies are autosomal ______________, and most defects in structural or non-catalytic proteins are autosomal ______________.

Recessive
Dominant

241

AV node produces heart rate of how many bpm?

45-55

242

How do you tell if genes are linked or inherited together?

Multiply individual frequencies together and if the observed frequency > calculated frequency, they are linked.

243

Tetanus toxin

Inhibits the inhibitory interneurons of motor neurons causing tetany

244

Best place to put a chest tube

4th or 5th intercostal space in mid-axillary line

245

Disease transmitted via armadillos

Mycobacterium leprae

246

Osler-Weber-Rendu Syndrome

AD inheritance of hereditary hemorrhagic telangectasias on mucosal surfaces that cause recurrent rupture and bleeding

247

AD inheritance of hereditary hemorrhagic telangectasias on mucosal surfaces that cause recurrent rupture and bleeding

Osler-Weber-Rendu Syndrome

248

von Recklinghausen's Disease/NF1

AD inheritance of PNS tumors - neurofibromas, optic nerve gliomas, Lisch nodules, cafe au lait spots

249

AD inheritance of PNS tumors - neurofibromas, optic nerve gliomas, Lisch nodules, cafe au lait spots

von Recklinghausen's Disease/NF1

250

NF2

AD inherited disorder causing nervous system tumors like bilateral CNVIII schwannomas and meningiomas

251

AD inherited disorder causing nervous system tumors like bilateral CNVIII schwannomas and meningiomas

NF2

252

Sturge-Weber Syndrome

Congenital anomaly causing port-wine birthmark, cutaneous facial angiomas, leptomeningeal angiomas, retardation, seizures, hemiplegia, tram-track skull opacities

253

Congenital anomaly causing port-wine birthmark, cutaneous facial angiomas, leptomeningeal angiomas, retardation, seizures, hemiplegia, tram-track skull opacities

Sturge-Weber Syndrome

254

Von-Hippel Lindau Diease

AD inherited disease cause capillary hemangioblastomas in retina and cerebellum, congenital cysts and neoplasms of the kidney, liver and pancreas

255

AD inherited disease cause capillary hemangioblastomas in retina and cerebellum, congenital cysts and neoplasms of the kidney, liver and pancreas

Von-Hippel Lindau Disease

256

Tuberous sclerosis

AD inherited disease causing seizures, kidney, liver and pancreatic cysts, cortical and subependymal hamartomas, cutaneous angiofibromas, renal angiomylipomas and cardiac rhabdomyomas

257

AD inherited disease causing seizures, kidney, liver and pancreatic cysts, cortical and subependymal hamartomas, cutaneous angiofibromas, renal angiomylipomas and cardiac rhabdomyomas

Tuberous sclerosis

258

Cystine kidney stones

Rare flat, yellow, hexagonal stones precipitating at low pH

259

Rare flat, yellow, hexagonal stones precipitating at low pH

Cystine kidney stones

260

Octahedron square crystal with X in the middle

Calcium oxalate stone

261

Elongated, wedge-shaped stone that can form rosettes

Calcium phosphate stone

262

Rectangle prism-shaped stone that resembles a coffin lid

Magnesium ammonium phosphate (struvite) stone

263

Yellow/brown diamond or rhombus shaped stone

Uric acid stone

264

Pioglitazone

Thiazolidinedione that activates intra-nuclear PPARy and causes increased tx of genes to increase adiponectin and increase insulin sensitivity

265

Which DNA polymerase removes RNA primers?

DNA Pol I

266

Which DNA polymerase has 5-3 exonuclease activity?

DNA Pol I

267

Which DNA polymerase has 5-3 polymerase and 3-5 exonuclease activity?

DNA Pol III

268

An increase in estrogen causes a/an _______________ in total thyroid hormone, but patients remain clinically euthyroid.

Increase

269

Holosystolic murmur heard over cardiac apex

MR

270

S3 gallop

Increased LV filling rate during mid-diastole

271

Blood supply to the femoral head

Medial circumflex artery

272

Caspofungin

Echinocandin that blocks glucan synthesis and prevents cell wall formation in mostly Candida and Aspergillus

273

Amphotericin B

Binds ergosterol in the fungal cell membrane and causes holes to form, increasing permeability and cell death but carries significant risk of renal toxicity

274

Treatment for mucormycosis

Amphotericin B to start and then posaconazole to maintain

275

Which 2 infections cause cold agglutination?

Mycoplasma pneumoniae
EBV

276

Which disease can be inherited via X-linked OR autosomal recessive pattern?

SCID

277

Foscarnet

Pyrophosphate analog used for ganciclovir-resistant CMV infections and can chelate calcium leading to hypocalcemia and cause renal wasting of magnesium causing hypomagnesemia leading to seizures

278

Pyrophosphate analog used for ganciclovir-resistant CMV infections and can chelate calcium leading to hypocalcemia and cause renal wasting of magnesium causing hypomagnesemia leading to seizures

Foscarnet

279

Drug used for gangicolovir-resistant CMV

Foscarnet

280

Rate limiting enzyme of the pentose phosphate pathway

G6PD

281

Heinz bodies

Aggregated hemoglobin in G6PD deficiency

282

Bite Cells

G6PD deficiency

283

Exercise causes a change in __________ PaO2 and PCO2 but NOT a change in ______________ PaO2 and PCO2.

Venous (more extraction and production)
Arterial (hyperventilation and improved V/Q matching)

284

Which 3 muscles does the superior gluteus nerve innervate

Gluteus medius
Gluteus minimus
TFL

285

Trendelenburg Sign

Pelvis sags to the contralateral side when the patient stands on the affected leg because the superior gluteal nerve is injured and the gluteus med/min can't stabilize the pelvis

286

Gluteus medius lurch

When a patient with a superior gluteal nerve injury is walking, they lean toward the affected/ipsilateral side to maintain a level pelvis

287

Lateral geniculate body

Thalamic structure that receives and transmits visual information

288

Thalamic structure that receives and transmits visual information

Lateral geniculate body

289

3 most common causes of post-viral secondary bacterial pneumonia

Strep pneumo
Staph aureus
Haemophilus influenza

290

Patent foramen ovale occurs from failure of what?

Failure of the septum primum to push against the septum secundum and fuse

291

What is the serum concentration of glucose where glucose starts to spill into the urine?

200

292

Garlic breath

Arsenic poisoning

293

Treatment of arsenic poisoning

Dimercaprol

294

The highest risk of bleeding on warfarin therapy occurs with what INR level?

>3.0

295

Treatment of infectious PID

Ceftriazone (gonorrhea) AND doxycycline or azithromycin (chlamydia)

296

Treatment for homocystinuria

Pyridoxine and cysteine
Restrict methionine

297

Pleiotropy

Many different phenotypes (often in different organ systems) as a result of a single gene defect

298

Bethanechol

Muscarinic agonist often used to treat post-op urinary retention

299

Which bacteria exhibits tumbling motility at cool temps <22*?

Listeria

300

What surface marker is most specific for the monocyte-macrophage lineage?

CD14

301

What is the most sensitive Ab test for SLE? Most specific?

Sensitive --> ANA
Specific --> anti-dsDNA and anti-snRNPs/anti-Smith

302

How do beta blockers affect heart rate? What is the corresponding effect on EKG?

Decrease AV nodal conduction, causing increased AV nodal refractory period and PR interval prolongation

303

Which classes of drugs significantly reduce mortality in patients with systolic CHF?

ACEIs
ARBs

304

4 aspects of Tetralogy of Fallot

1. VSD
2. Overriding aorta
3. RV outflow obstruction (pulm stenosis)
4. RVH

305

Drug of choice for trigeminal neuralgia

Carbamazepine

306

Mechanism of carbamazepine

Inhibits neuronal firing by reducing ability of Na channels to recover from inactivation

307

What drug is given for beta blocker overdose?

Glucagon

308

MCC of acute suppurative bacterial parotitis

Staph aureus

309

Antibodies to desmogleins 1 and 3

Pemphigus vulgaris

310

Flaccid blistering disease vs intact blistering disease

Flaccid -- phemphigus vulgaris (anti-desmosomes)
Intact -- bullous pemphigoid (anti-hemidesmosome)

311

Which hormone upregulates gap junctions in the myometrium during labor?

Estrogen

312

Which hormone increases expression of oxytocin receptors on the myometrium during labor?

Estrogen

313

Length Constant

Measure of how far along an axon and electrical impulse can propagate

314

What is the most common method of overdose deaths in the US?

Opioids

315

MCC of acute hypocalcemia

Injury to parathyroids during thyroid surgery

316

Chvostek Sign

Indicates hypocalcemia

317

Trousseau Sign

Indicates hypocalcemia

318

Meckel's Diverticulum

Occurs from failure of obliteration of the omphalomesenteric (vitelline) duct

319

Intussception presentation

Colicky abdominal pain and currant jelly stools

320

How do you identify a Meckel's Diverticulum?

Radioisotope Tc pertechnetate scan which is specific for parietal cells and since Meckel's often have gastric mucosa in them, it will take up the dye and can be visualized

321

What is the Candida Test?

Inject candida under the skin and look for induration which identifies normal T-cell response, and if there is NO induration there is an abnormal T-cell response

322

Birbeck granule

Tennis-racket shaped granule in Langerhans DCs

323

Harsh crescendo-decrescendo systolic ejection murmur best heard along LLSB and apex

LV outflow tract obstruction due to HOCM

324

Which change in preload allows one to hear the murmur of HOCM easier?

Decreased --> Valsalva, abrupt standing, nitroglycerin

325

Which region of the male urethra is weakest and prone to injury?

Membranous segment

326

What 2 drugs can you treat acyclovir-resistant herpesvirus with?

Cidofovir
Foscarnet

327

When does acute rheumatic fever occur after a Group A strep pharyngitis infection?

2-4 weeks

328

What is the most frequently reported serious adverse event?

Wrong-site surgery

329

GLUT4

Insulin-sensitive glucose transporter in the muscle and adipose

330

GLUT2

Export of glucose from liver, kidney, and small intestine and controls insulin secretion in pancreas

331

3 beta-lactamase inhibitors

Clavulanate
Sulbactam
Tazobactam

332

Bethanechol

Cholinergic agonist used to prevent post-op ileus and bladder atonia/urinary retention.

333

Cholinergic agonist used to prevent post-op ileus and bladder atonia/urinary retention

Bethanechol

334

Pilocarpine

Cholinergic agonist used to lower intraocular pressure in glaucoma

335

Carbachol

Cholinergic agonist used to lower intraocular pressure in glaucoma

336

2 most common causes of acute pancreatitis

Gallstones
Alcoholism

337

Of the drugs that cause QT prolongation, which drug actually has the LEAST likelihood of inducing Torsades?

Amiodarone

338

What is the function of thyroxine peroxidase

Iodination of thyroglobulin

339

What are the antibodies against in autoimmune Hashimoto's thyroiditis?

Thyroid peroxidase

340

What is the difference between topoisomerase I and II?

I --> makes single strand nicks to relieve neg supercoiling
II --> makes double strand breaks to relieve neg AND pos supercoiling

341

Etoposide

Inhibits topoisomerase II causing double strand breaks in DNA and cell death in testicular and small cell lung cancer

342

Podophyllin

Inhibits topoisomerase II causing double strand DNA breaks in genital warts

343

3 mitochondrial myopathies

Myoclonic epilepsy with ragged red fibers (MERRF)
Leber optic neuropathy
Mitochondrial encephalopathy with stroke and lactic acidosis (MELAS)

344

After how long will cardiac ischemia cause IRREVERSIBLE loss of contractile function?

30 minutes

345

Chocolate agar

H influenza

346

Thayer-Martin agar

Neisseria

347

Bordet-Gengou agar

Bordatella pertussis

348

Regan-Lowe medium

Bordatella pertussis

349

Tellurite agar

C diphtheria

350

Loffler medium

C diphtheria

351

Lowenstein-Jensen agar

Mycobacterium tuberculosis

352

Easton agar

Mycobacterium pneumoniae

353

MacConkey agar

Lactose-fermenting enterics

354

Eosin-methylene blue agar

Ecoli

355

Charcoal yeast agar

Legionella

356

Sabouraud agar

Fungi

357

What factors are added to chocolate agar? And for which organism?

H flu --> Factor V (NAD) and Factor X (hematin)

358

Which 4 antibiotics are part of Thayer-Martin agar and what organism does it grow?

Neisseria --> vancomycin, trimethoprim, colistin, nystatin

359

Which agar requires cholesterol and what does it grow?

Eaton agar --> Mycobacterium pneumoniae

360

Which 3 organisms are obligate aerobes?

Nocardia
Pseudomonas
Mycobacterium TB

361

Which class of antibiotics is completely ineffective against anaerobes and why?

Aminoglycosides --> require O2 to enter the bacterial cells

362

Which 3 bugs are obligate intracellular?

Rickettsia
Chlamydia
Coxiella

363

Which 3 vaccines are made of capsule conjugated to carrier protein?

Pneumococcal
Hflu
Meningococcal

364

Patients with chronic granulomatous disease have recurrent infections with which type of microbe?

Catalase positive

365

Recurrent infections with catalase-positive organisms

Chronic granulomatous disease

366

Yellow sulfur granules

Actinomyces Israelii

367

Protein A virulence factor

Binds Fc region of IgG and prevents opsonization and phagocytosis released by Staph aureus

368

Which 2 classes of microbes are spore-producing

Clostridium
Bacillus

369

Which is more fatal at the same dose, exotoxins or endotoxins?

Exotoxins

370

What 3 cytokines do bacterial endotoxins induce?

TNFa
IL1
IL6

371

Which 2 exotoxins inactivate EF2?

Diphtheria toxin
Exotoxin A from pseudomonas

372

Which 2 organisms produce shiga toxin?

Shigella
EHEC

373

What is the function of shiga toxin?

Inactivates the 60S ribosome by removing adenine from rRNA

374

What is the serious result of shiga toxin?

Hemolytic uremic syndrome

375

What is the difference between heat-labile and heat-stable toxin produced by ETEC?

Heat-labile --> increases cAMP leading to increased Cl and H20 secretion in gut

Heat stable --> increases cGMP leading to decreased reabsorption of NaCL and H20 in gut

376

What is the function of edema factor and which microbe produces it?

Bacillus --> mimics adenylate cyclase to increase cAMP causing edema

377

What is the function of cholera toxin?

Permanently binds to G2 subunit, causing overactivation of adenylate cyclase causing increased cAMP --> increased Cl and H20 secretion

378

What is the function of pertussis toxin?

Binds to and disables Gi subunit leading to overactivation of adenylate cyclase and increased cAMP causing impairment of phagocytosis

379

What is the function of tetanospasmin and botulinum toxins?

Proteases that cleave SNARE proteins preventing the release of secretory neurotransmitters

380

Tetanospasmin

Tetanus toxin that prevents the release of inhibitory GABA and glycine release in Renshaw cells in the spinal cord leading to spastic paralysis

381

Botulinum toxin

Prevents the release of ACh at the NMJ resulting in flaccid paralysis

382

What is the function of alpha toxin and what microbe secretes it?

C perfringens --> it's a phospholipase that degrades cell membranes and tissues causing necrosis and hemolysis

383

What is the function of streptolysin O and what microbe produces it?

Group A strep (pyogenes) --> degrades cell membrane causing hemolysis

384

Which 2 microbes release superantigens?

Staph aureus --> TSST1
Group A strep pyogenes --> exotoxin A

385

Superantigen binding to TCR and MHCII causes release of which 4 cytokines?

TNFa
IFNy
IL1
IL2

386

Which bacteria have LPS and what are the components?

Gram negative --> O antigen + polysaccharide + Lipid A

387

What are the 3 main effects of LPS?

1. Macrophage activation
2. Complement activation
3. TF activation

388

What is the mechanism of MRSA resistance?

Altered penicillin binding proteins

389

MCC of endocarditis in prosthetic valves

Staph epidermidis

390

MCC of endocarditis on damaged heart valves

Strep viridans

391

Most bacterial capsules are made of polysaccharides, but one is made of polypeptides, which bacteria is it?

Bacillus

392

Which disease is common among sheep farmers?

Pulmonary anthrax

393

Most potent type of diuretic

Loop diuretic

394

Which 3 TCA enzymes use NAD as a co-factor?

Isocitrate dehydrogenase
A-ketoglutarate dehydrogenase
Malate dehydrogenase

395

NAD tends to be used for ___________ reactions like ____ and _____, whereas NADP tends to be used for __________ reactions like ________ and _________.

NAD --> catabolic, glycolysis, beta-oxidation
NADP --> anabolic, fatty acid synthesis, cholesterol synthesis

396

Microbe that lives on decaying vegetables

Aspergillus

397

Type I vs Type II pneumo Yates

Type I --> flat, cover alveoli, can't regenerate
Type II --> cuboidal, make surfactant, regenerate into both types

398

Which 3 drugs can be used to treat Cdiff?

Vancomycin
Metroidazole
Fidaxomicin

399

Fidaxomicin

Macrocyclic antibiotic that inhibits the sigma subunit of RNA pol leading to decreased protein synthesis and cell death and is used to treat recurrent Cdiff

400

Ivabradine

Selectively inhibits funny Na channels leading to prolonged phase 4 depolarization in the SA node, slowing the HR without affecting contractility or relaxation and is used in severe, refractory CHF

401

Selectively inhibits funny Na channels leading to prolonged phase 4 depolarization in the SA node, slowing the HR without affecting contractility or relaxation and is used in severe, refractory CHF

Ivabradine

402

Sensory innervation of internal vs external anal canal

Internal --> autonomic branch from inferior hypogastric plexus
External --> somatic branch from pudendal nerve

403

Bosentan

Endothelin receptor antagonist that blocks the vasoconstriction and endothelial proliferation of endothelin, thereby causing vasodilation and decreased pulm artery pressure in PAH

404

Endothelin receptor antagonist that blocks the vasoconstriction and endothelial proliferation of endothelin, thereby causing vasodilation and decreased pulm artery pressure in PAH

Bosentan

405

At which lung volume is PVR the LOWEST?

FRC

406

Tetrodotoxin

Pufferfish toxin that binds to Na channels and inhibits influx, decreasing depolarization and action potential firing

407

Latanoprost

Topical prostaglandin that decreases collagen content in the eye and increases outflow of aqueous humor in open-angle glaucoma

408

Snowstorm pattern of uterus on US

Complete mole

409

Most cases of trisomy 21 occur from what?

Nondisjunction in maternal miosis 1

410

Which cytokine is associated with B-cell growth and isotype switching?

IL4

411

Which cytokines increase B-cell differentiation to produce IgE and IgA?

IL4 --> IgE and type I hypersensitivity
IL5 --> IgA and eosinophils

412

Which cytokine stimulates IgA and eosinophil production and is important in parasite infections?

IL5

413

What type of receptor and messenger system does glucagon use?

GPCR (Gs), adenylate cyclase system

414

What are the 2 metabolic products of homocysteine and what co-factors are required for each?

Cysteine --> VitB6
Methionine --> THF, VitB12

415

Accumulation of which biochemical metabolite is a significant risk factor for thrombosis?

Homocysteine

416

Effect of Niacin in hyperlipidemia

Decreases hepatic synthesis of triglycerides and VLDL and decreases the clearance of HDL

417

Which anti-hyperlipidemia drug is associated with decreased renal excretion of uric acid and can precipitate gout attacks?

Niacin

418

Which anti-hyperlipidemia drug can actually INCREASE blood levels of triglycerides?

Bile acid resins (cholestyramine)

419

Polycistronic

A single mRNA can encode for more than one protein (prokaryotes only)

420

What is the function of the ventral posterior thalamus?

Relay sensory tract information up to somatosensory cortex

421

What are the 2 divisions of the ventral posterior thalamus and what do they do?

Ventral posterior lateral --> relay spinothalamic tract and dorsal columns
Ventral posterior medial --> relay trigeminal pathway

422

What is absolutely required for infection with HepD virus?

HBsAg

423

CMV

Herpesvirus (enveloped dsDNA)

424

At what age should the MMR be given?

12-15 months

425

Which 2 diseases present with maculopapular rash that starts on the head and spreads downward?

Measles
Rubella

426

Fetal infection with rubella causes what symptoms?

Deafness, cataracts, cardiac malformations like PDA

427

Most common tachyarrythmia

Atrial fibrillation

428

Which class of drugs is associated with neonatal Potter Syndrome?

ACEIs and ARBs

429

How does PCP work?

NMDA receptor antagonist

430

What is the most common manifestation of osteoporosis?

Vertebral fractures

431

Which type of bone is affected FIRST in osteoporosis and which is later?

Early --> cancellous bone (vertebrae)
Later --> cortical bone (long bones)

432

Which drug is used in atropine toxicity?

Physostigmine

433

Which AChE inhibitor is able to cross the BBB?

Physostigmine

434

Frequent bone mets

PB/KTL (lead kettle) --> prostate, breast, kidney, thyroid, lung

435

Most common benign liver tumor

Cavernous hemangioma

436

What type of liver tumor can regress with discontinuation of OCPs?

Hepatic adenoma

437

Which liver tumor is associated with hemochromatosis?

HCC

438

MEN2A

Pheo
Medullary thyroid cancer
Parathyroid hyperplasia

439

MEN2B

Pheo
Medullary thyroid carcinoma
Gastric/mucosal neuromas

440

From what structures are the adrenal cortex and medulla derived from?

Cortex --> mesoderm
Medulla --> neural crest cells

441

What is the mnemonic for structures derived from neural crest cells?

MOTEL PASS

442

Fabry Disease

X-linked recessive mutation in alpha-galactosidase A causing increased accumulation of ceramide/Gb3

443

Angiokeratomas

Dark red non-blanching macules and papules usually in clusters on butt, groin and umbilicus

444

Dark red non-blanching macules and papules usually in clusters on butt, groin and umbilicus

Angiokeratoma

445

Entacapone

COMT inhibitor that increases bioavailability of levodopa by blocking the peripheral degradation to 3-OMD

446

Which 4 enzymes is thiamine a cofactor for?

1. PDH
2. Alpha-ketoglutarate dehydrogenase
3. Transketolase
4. Branched-chain a-ketoacid dehydrogenase

447

How does the mutated huntingtin protein cause neurodegenerative disease?

Impaired huntingtin protein causes histone deacetylation and transcriptional repression of genes necessary for neuron survival

448

Most common cause of septic arthritis in patients with prosthetic joints

Staph epidermidis

449

Adenomyosis

Presence of endometrial glandular tissue within myometrium common in middle-aged parous women and causes painful, heavy menstrual bleeding (dysmenorrhea)

450

How does glucagon infusion during hypoglycemia cause an increase in glucose?

Glucagon --> GPCR --> increases cAMP --> activates PKA --> activates glycogen phosphorylase --> glycogenolysis

451

Jervell and Lange-Nielsen Syndrome

AR inheritance of mutations in genes that encode the alpha and beta subunits of K-channels leading to bilateral sensorineural hearing loss and long QT syndrome

452

Alpha1-mediated vasoconstriction occurs via what type of pathway?

IP3

453

Through what type of receptor pathway does B1-mediated stimulation in the heart occur?

GPCR Gs/cAMP

454

What are the effects of NE and via what receptor pathways?

Alpha1 --> increased IP3 --> vasoconstriction
Alpha2 --> decreased cAMP --> decreased release of NE, insulin
Beta1 --> increased cAMP --> increased contractility

455

Which class of drugs can reduce prostate volume in BPH?

5-alpha reductase inhibitors

456

After what gestational age does mature surfactant develop?

After 32-33 weeks

457

What is the most common cause of hirsutism?

PCOS

458

How do OCPs treat hirsutism in PCOS patients?

Suppress release of LH --> decreased ovarian androgen production
Increase sex-hormone binding globulin release from the liver --> decreased free testosterone

459

Which substance is used to measure GFR? RBF?

GFR --> inulin or creatinine
RBF --> PAH

460

Most common cause of viral meningitis

Enteroviruses (Coxsackie, echovirus, poliovirus)

461

Ecthyma gangrenosum

Necrotic lesions due to pseudomonas

462

How does Crohn's Disease cause increased risk of kidney stones?

Damage to terminal ileum causes fat malabsorption and the fats bind to calcium to excrete it in the feces, leaving oxalate to be absorbed and precipitates as oxalate kidney stones

463

What is the only medication that reverses both the muscarinic and nicotinic effects of organophosphate poisoning?

Pralidoxime

464

How is severity of aortic regurgitation measured?

Duration of the diastolic murmur (mild = early diastole, severe = holodiastolic)

465

What are the 2 effects of digoxin?

1. Inhibits Na-K ATPase --> increases Ca --> increases contractility
2. Increases vagal tone causing decreased conduction through the AV node

466

What signals the release of E and NE from the adrenal medulla

Preganglionic sympathetic neurons release ACh onto chromaffin cells

467

Krunkenberg tumor

Primary gastric signet ring cell malignancy that mets to ovary

468

Accumulation of what causes Alzheimer's Disease

Intracellular neurofibrillary tangles
Extracellular amyloid-beta (AB) plaques

469

Tau protein

Component of neurofibrillary tangles in Alzheimer's

470

Acetyl CoA carboxylase

Converts acetyl CoA to malonyl CoA during fatty acid synthesis

471

Acyl CoA synthetase

Activates fatty acids in the cytoplasm so that they can undergo beta-oxidation in the mitochondria to form acetyl CoA to be used in energy production and ketogenesis

472

Fatty acid synthesis and oxidation occur where?

Beta oxidation --> mitochondria
FA synthesis --> cytoplasm

473

ATP Citrate Lyase

Converts citrate that was carrying Acetyl CoA from the mitochondria (from TCA cycle) into the cytoplasm to free acetyl CoA to be used in fatty acid synthesis

474

What is a blood marker for osteoblastic activity?

Serum bone-specific alk phos

475

What release alkaline phosphatase?

Liver, bone, placenta, intestine

476

What metabolism deficiency presents very similarly as Marfan's?

Homocysteinuria

477

What are 2 substances produced by granulomas in sarcoidosis?

ACE
1,25OH VitD

478

Which vessel is likely to be ruptured causing bleeding in a duodenal ulcer?

Gastroduodenal

479

3 most important components of granulomas

Macrophages
Giant cells
CD4 cells

480

Canagliflozin and Dapagliflozin

SGLT2 inhibitors that block the uptake of glucose in the low-affinity, high-capacity SGLT2 transporter in the PCT causing glucose wasting in the urine treating diabetes

481

Function of azoles

Inhibit the demethylation of lanosterol into ergosterol for the fungal cell membrane and cause membrane dysfunction

482

Risedronate

A bisphosphonate that binds to hydroxyapatite sites on bony surfaces and when osteoclasts resorb the bone containing the drug, they become ineffective and undergo apoptosis

483

Which class of diuretics can improve survival in patients with decompensated heart failure?

Mineralocorticoid receptor antagonists/K-sparing diuretics (spironolactone, eplerenone)

484

Which 3 drugs are most commonly recommended in heart failure?

ACEIs
Beta blockers
K-sparing diuretics

485

Unfractionated heparin

Binds to antithrombin and causes increased activity to inhibit Factor Xa and thrombin

486

Enoxaparin

LMWH that binds to anti-thrombin and increases activity to inhibit Factor Xa

487

Fondaparinux

Synthetic pentasaccharide that binds to anti-thrombin and inhibits Factor Xa

488

What is the MCC of mitral stenosis?

Rheumatic fever

489

Ausculatory findings in mitral stenosis

Loud S1, then early diastolic opening snap, and then mid-diastolic murmur

490

Loud S1, then early diastolic opening snap, and then mid-diastolic murmur

Mitral stenosis

491

Best treatment of group A strep

Penicillins!

492

Maternal prophylaxis for group B strep

Penicillin G

493

Abx of choice for surgical prophylaxis

Cefazolin

494

Meningitis empiric treatment

Ceftriaxone
Vancomycin
Ampicillin (if listeria suspected)

495

Cephalosporin of choice that covers pseudomonas

Ceftazadime

496

Which cephalosporin has coverage against MRSA?

5th generation - ceftaroline

497

First line empiric treatment of endocarditis

Vancomycin

498

Xeroderma pigmentosum

AR disorder of endonuclease which is unable to repair pyrimidine dimers in the DNA causing severe photosensitivity and skin cancer

499

Which viruses are segmented?

BOAR --> bunya, orthomyxo, arena, reo/rota

500

Ezetimibe

Inhibits the luminal NPC1L1 channel from taking up cholesterol in the enterocytes, leading to decreased intra-hepatic stores and increased expression of LDLR to take up more cholesterol and lower blood cholesterol levels

501

Vernet Syndrome

Lesions of jugular foramen leading to defects in CNIX, X and XI

502

Bloom Syndrome

Rare AR disorder caused by mutation in DNA helicase leading to chromosome instability and breakage and causes growth retardation, facial anomalies, photosensitive rash and immunodeficiency

503

Where are the superficial inguinal nodes located?

Femoral triangle

504

Methotrexate

Anti-folate drug that inhibits purine and pyrimidine synthesis by competitive inhibition of dihydrofolate reductase

505

Treatment for acute delirium

Haloperidol

506

Which of the sugars can be metabolized in glycolysis FASTEST? Why?

Fructose (bypasses PFK1 which is the rate-limiting enzyme of glycolysis)

507

Baclofen

GABAb receptor agonist causing increased inhibitory neuronal activity and is used to treat spasticity from brain and spinal cord diseases

508

Sandpaper like rash

Scarlet fever (strep pyogenes)

509

Anti-SSA and SSB

Sjogren syndrome

510

Anti-centromere Abs

CREST Syndrome

511

Anti-topoisomerase I Abs

Diffuse scleroderma

512

Anti-ribonucleotide antibodies

Sjogren's Syndrome

513

Anti-U1 ribonucleoprotein (RNP)

Mixed CT Disease

514

HLA-A3

Hemochromatosis

515

HLA-B8

Addison's Disease
Myasthenia Gravis

516

HLA-B27

Seronegative spondylarthropathies

517

HLA-DQ2/DQ8

Celiac disease

518

HLA-DR2

MS
SLE
Goodpasture Syndrome

519

HLA-DR3

T1DM
SLE
Grave's disease
Hashimoto thyroiditis
Addison's disease

520

HLA-DR4

T1DM
RA
Addison's disease

521

HLA-DR5

Pernicious anemia
Hashimoto thyroiditis

522

Potter Syndrome

Renal agenesis or other renal abnormality causes oligohydramnios which leads to flat facies, pulmonary hypoplasia and limb deformities

523

Which region of the nephron is impermeable to water?

Ascending loop of henle
Early DCT

524

Call-Exner bodies

Rosettes of granulosa cells with coffee-bean nuclei around a pink eosinophilic material in the center and indicate a granulosa cell tumor

525

Which cells are responsible for the intense inflammatory response in gout?

Neutrophils

526

Colchicine

Interferes with microtubule formation causing impaired neutrophil activation, migration and phagocytosis of gout crystals decreasing the inflammatory response associated with gout

527

What is the splice sequence of mRNA?

GU - AG

528

Gram pos lancet-shaped diplococci

Strep pneumo

529

Wiskott-Aldrich Syndrome triad

Eczema
Thrombocytopenia
Recurrent infections (B and T-cell deficiency)

530

Nitroprusside

Short-acting venodilator and vasodilator that decreases preload and afterload but NOT stroke volume

531

How do NK cells kill virus or cancer-infected cells?

Release perforins that make holes in the cell, and then release granzymes which go through the holes and induce cell apoptosis

532

What are the 2 possible surface markers of NK cells?

CD56
CD16

533

What 2 cytokines activate the development of NK cells?

IFNy
IL12

534

When a clavicle breaks, what is the direction of displacement of the medial and lateral halves?

Medial --> displaced superior and posterior due to SCM
Lateral --> displaced inferior and anterior due to pec major and arm

535

Which polymerase is involved in eukaryotic gene transcription?

RNA Pol II

536

2 most common causes of acute otitis media?

Strep pneumo
Hflu

537

Involuntary head bobbing is a sign of what?

Widened pulse pressure

538

Isoniazid is chemically similar to what vitamin?

VitB6

539

Izoniazid must be co-administered with what and why?

Pyridoxine (VitB6) -- it competes with VitB6 in synthesis pathways and increases urinary excretion causing peripheral neuropathy

540

Hereditary angioedema

AD inherited defect in C1 esterase inhibitor leading to increased complement and bradykinin pathways causing episodes of edema

541

What class of medications is contraindicated in hereditary angioedema?

ACEIs (increases bradykinin and causes more edema)

542

Gp120

HIV viral envelope protein encoded by the env gene that mediates attachment by binding to CD4 receptors on T-cells

543

gp41

HIV transmembrane protein encoded by the env gene that mediates viral fusion to the host T cell for invasion

544

In which part of the cell is proinsulin cleaved to mature insulin and C-peptide?

Secretory granules

545

What are the 2 ways in which radiation therapy induces cell death?

Double strand DNA breaks
Free radical formation

546

Which immunoglobulins bind complement?

IgG
IgM

547

Which Ig crosses the placenta?

IgG

548

Which Ig molecules are made with a J chain?

IgA
IgM

549

DAF deficiency

Deficiency in GPI-anchored enzymes that leads inability to prevent complement from binding to RBCs and increased lysis causing PNH

550

IL1

Secreted by macrophages and causes fever, inflammation, activates endothelial cells to express adhesion molecules, induces chemokine secretion

551

Which interleukin is also called osteoclast-activating factor?

IL1

552

IL6

Produced by macrophages to cause fever and stimulate production of acute phase proteins

553

Major interleukin involved in stimulating production of acute phase proteins

IL6

554

IL8

Secreted by macrophages as a chemotactic for PMNs

555

Which interleukin is the major chemotactic factor for PMNs?

IL8

556

IL12

Secreted by macrophages to induce differentiation of T cells into TH1 cells and activate NK cells

557

Which interleukin mediates the differentiation of T cells into TH1 cells?

IL12

558

Which interleukin activates NK cells?

IL12

559

TNFa

Secreted by macrophages and induces septic shock

560

Which cytokine is important in inducing septic shock?

TNFa

561

Which 2 cytokines are secreted by ALL T cells?

IL2
IL3

562

Which cytokines are secreted by macrophages?

IL1
IL6
IL8
IL12
TNFa

563

IL2

Secreted by all T cells to stimulate growth of all types of T cells and NK cells

564

IL3

Released by all T cells and supports growth and maturation of bone marrow stem cells

565

Which cytokine acts like GM-CSF and activates growth and differentiation of bone marrow?

IL3

566

IFNy

Secreted by NK cells and TH1 cells in response to IL12 from macrophages to stimulate macrophage killing of phagocytosed microbes and NK cells to kill virus infected cells

567

Which cytokine activates NK cells to be able to kill virus infected cells?

IFNy

568

Which cytokine activates macrophages to kill endocytosed pathogens?

IFNy

569

Which cytokines are released from TH2 cells?

IL4
IL5
IL10

570

Which cytokines are ANTI-inflammatory?

IL10
TGFB

571

IL4

Released by TH2 cells to induce differentiation of T cells into TH2 cells, promotes class switching to IgG and IgE

572

Which cytokine induces class switching to IgG?

IL4

573

Which cytokine induces class switching to IgE?

IL4

574

IL5

Secreted by TH2 cells to promote class switching to IgA and stimulates growth of eosinophils

575

Which cytokine induces class switching to IgA?

IL5

576

Which cytokine stimulates growth of eosinophils?

IL5

577

IL10

Secreted by TH2 and Tregs to down-regulate the inflammatory response and inhibit inflammatory cells

578

Which is the ONLY live vaccine given to HIV patients?

MMR

579

Where is ADH synthesized?

Paraventricular and supraoptic nuclei of hypothalamus

580

What must be true in order for the NPV of a test to be generalizable to an individual patient?

The patient's pretest probability must be equivalent to the disease prevalence in the study population

581

What is the leading cause of blindness in developed countries?

Age-related macular degeneration

582

When does the neural tube form?

20-22 days

583

Neural tube defects

Failure of either the anterior or posterior neuropore of the neural tube to close by 4 weeks

584

3 drugs that can cause NTDs

Valproate
TMP-SMX
Methotrexate

585

Where are short-chain and long-chain fatty acids metabolized by beta-oxidation?

Short-chain -- mitochondria
Long-chain -- peroxisomes

586

Best drug treatment for bulimia nervosa

Fluoxetine (or another SSRI)

587

Functions of troponin T, I and C

T -- binds other troponin components to tropomyosin
I -- binds tropomyosin to actin
C -- binds Ca to cause muscle contraction

588

Which 2 drugs are used in identifying ischemic areas of the myocardium and cause the coronary steal phenomenon?

Adenosine
Dipyridamole

589

What are 2 equations to calculate CO?

CO = SV x HR
CO = vO2 / (CaO2 - CvO2)

590

Donepezil

Cholinesterase inhibitor that causes increased cholinergic transmission in patients with Alzheimer's disease and may improve functioning and slow progression

591

Where are parietal cells located?

Upper part of the gastric glands in the body and fundus

592

Achondroplasia

Sporadic or autosomal dominant mutation causing constitutive expression of FGFR3

593

Which disease is associated with advanced paternal age?

Achondroplasia

594

Atopic dermatitis

Chronic inflammatory skin condition causing flares of intensely pruritic diffuse eczema and lichenification on flexor surfaces

595

Chronic inflammatory skin condition causing flares of intensely pruritic diffuse eczema and lichenification on flexor surfaces

Atopic dermatitis

596

What is used to measure fetal lung maturity?

Amniotic fluid lecithin (phosphatidylcholine) to sphingomyelin ratio

597

Which 3 microbes can infect the biliary tract and can cause formation of brown pigment gallstones?

Ecoli
Ascaris lumbricoides
Clonorchis sinensis

598

What is the difference between bipolar disorder with psychotic features and schizoaffective disorder?

Psychosis occurs ALL THE TIME alongside the mood symptoms with schizoaffective disorder, but psychosis ONLY occurs during episodes of mood symptoms in bipolar disorder with psychotic features

599

How does colchicine work in the treatment of acute gout?

Binds to tubulin protein and prevents aggregation of MTs causing disruption of chemotaxis, phagocytosis and degranulation and decreases the formation of LTB4

600

A positive lepromin skin test indicates which type of leprosy infection and why?

Milder tuberculoid leprosy because it is a result of a vigorous TH1 response so it would NOT be positive in severe lepromatous leprosy because of the lack of TH1 response (and more of a TH2 response)

601

Cocaine

Inhibits the reuptake of monoamines (NE, DA, serotonin) and causes potent vasoconstriction

602

2 drugs used to treat peri-infarction pericarditis

Aspirin
Colchicine

603

4 substances that induce neutrophil chemotaxis

LTB4
C5a
IL8
Bacterial products

604

Myasthenia gravis is associated with hyperplasia and benign masses of what organ?

Thymus (thymomas)

605

White reflex

Retinoblastoma

606

What are the levels of K, Na and glucose during DKA?

Hyperkalemia (but total body stores of K are LOW)
Hyponatremia
Hyperglycemia

607

What drug is given to patients before surgical removal of a pheo?

Phenoxybenzamine (irreversible alpha-blocker)

608

What is the most significant risk of infant intraventricular hemorrhage?

Prematurity

609

Intraventricular hemorrhage in infants is caused by what and where?

Weak germinal matrix that spontaneously hemorrhages into the caudate nucleus, thalamus and ventricles causing hydrocephalus

610

Presbycusis

Loss of high-frequency hearing with age due to degeneration of apical stereocilia

611

Which chemotherapy drug is associated with tinnitus and hearing loss?

Cisplatin

612

LTB4

Chemotaxis

613

LTC4

Vasoconstriction
Bronchospasm
Increased permeability

614

LTE4

Increased permeability

615

Most cancers of the head and neck

Squamous cell carcinoma

616

Montelukast

Leukotriene D4 receptor antagonist used to treat bronchospasm and bronchial mucous secretion in asthma

617

Maple Syrup Urine Disease

Defect in branched-chain alpha-ketoacid dehydrogenase that uses thiamine B1 as a cofactor causing branched chain amino acids and alpha-ketoacids to accumulate

618

Adult Hgb

2alpha, 2 beta chains

619

Fetal Hgb

2 alpha, 2 gamma chains

620

Low concentration of testosterone in the seminiferous tubules but normal in the blood suggests dysfunction of what?

Decreased Sertoli cell production of androgen-binding protein

621

Linear deposits on immunofluorescence of the glomerulus

Deposits of IgG and C3 in anti-GBM (goodpasture's) disease

622

Goodpasture Syndrome

Anti-GBM antibodies that react with type IV collagen in the BM of the glomerulus and alveoli causing rapidly progressive crescentic GN and pulmonary hemorrhage

623

T(14;18)

Follicular lymphoma - moves BCL2 near the Ig heavy chain enhancer causing overexpression of BCL2 and pro-survival of B-cells in follicles

624

Qualitative vs Quantitative variables

Qualitative --> represent categories or groups
Quantitative --> represent numerical values

625

Which 2 vasculitides have granulomatous inflammation of the media, intimal thickening and giant cell formation?

Giant-cell temporal arteritis
Takayasu arteritis

626

What is the normal Babinski response?

Plantarflexion

627

What is a positive Babinski sign?

Dorsiflexion with toe spreading

628

A positive Babinksi sign is normal in infants until what age?

12 months

629

What is the best ausculatory evidence of severity of mitral stenosis? Mitral regurgitation?

MS -- S2 to opening snap interval
MR --presence of S3 gallop

630

Tubular concentration of PAH is lowest where? Why?

Bowman's space -- only some is filtered and MOST is actively secreted in the proximal tubule and concentration only increases along the nephron

631

Where are most gastric ulcers located?

Lesser curvature at the transitional zone between body and antrum

632

Triad of disseminated gonococcal infection

Polyarthralgias, skin lesions, tenosynovitis

633

What hormone stimulates prolactin release during pregnancy? What hormone inhibits it?

TRH stimulates it
Progesterone inhibits it

634

Where is progesterone produced during pregnancy?

1st trimester -- corpus luteum
2nd, 3rd trimesters -- placenta

635

3 components in the kidney that regulate RAAS

Macula densa (senses Na load)
Intra-renal baroreceptors
Beta1-adrenergic receptors on JGA cells

636

Do beta-blockers have an effect on renin? how?

Yes, blocks Beta-1 adrenergic receptors on the JGA cells and decrease release of renin

637

Risperidone

Anti-psychotic that inhibits D1 and D2 receptors (and also some serotonin and alpha-adrenergic)

638

Selegiline

MAO type B inhibitor used to delay progression of Parkinson's disease

639

How do androgens cause acne?

Stimulate follicular epidermal hyperproliferation and cause excessive sebum production

640

Which structures run anteriorly on the medial epicondyle of the humerus? Lateral epicondyle?

Medial -- median nerve, brachial artery
Lateral -- radial nerve

641

Acanthosis nigricans is associated with what malignancy?

Gastric adenocarcinoma

642

Sign of Leser-Trelat

Sudden onset of numerous seborrheic keratoses associated with an underlying GI adenocarcinoma

643

Which malignancy is associated with elevated 1,25 OH-VitD (Calcitriol) levels?

Lymphoma

644

What malignancy is associated with Cushing Syndrome?

Small cell lung cancer (increased ACTH)

645

What malignancy is associated with hyponatremia?

Small cell lung cancer (increased ADH - SIADH)

646

What malignancy is associated with a pure red cell aplasia?

Thymoma

647

What malignancy is associated with Good Syndrome/hypogammaglobulinemia?

Thymoma

648

Good Syndrome

Hypogammaglobulinemia associated with a thymoma

649

Trousseau Syndrome

Migratory superficial thrombophlebitis associated with pancreatic adenocarcinoma

650

What malignancy is associated with non-bacterial thrombotic endocarditis?

Pancreatic adenocarcinoma

651

What malignancy is associated with anti-NMDA receptor encephalitis?

Ovarian teratoma

652

What malignancies in children and adults are associated with "dancing eyes, dancing feet?"

Opsoclonus-myoclonus ataxia associated with neuroblastoma in children and small cell lung cancer in adults

653

Anti-NMDA Receptor encephalitis

Psychiatric sx, memory deficits, seizures, dyskinesias and other neurological deficits associated with ovarian teratoma

654

Opsoclonus-myoclonus ataxia syndrome

Dancing eyes and dancing feet associated with pediatric neuroblastoma and adult small cell lung cancer

655

What malignancies are associated with paraneoplastic cerebellar degeneration?

Small cell lung cancer
Gynecological and breast cancers
Hodgkin lymphoma

656

Anti-Yo, anti-Hu and Anti-Tr

Antibodies against antigens in Purkinje cells that causes paraneoplastic cerebellar degeneration from small cell lung cancer, Hodgkin lymphoma or gynecological/breast malignancies

657

Anti-Hu antibodies

Characteristic of paraneoplastic encephalomyelitis caused by small cell lung cancer

658

Which malignancy is associated with paraneoplastic encephalomyelitis?

Small cell lung cancer

659

Lambert Eaton Myasthenic Syndrome

Antibodies against presynaptic Ca channels at the NMJ and is associated with small cell lung cancer

660

Lambert-Eaton and Myasthenia gravis are associated with what malignancies?

Lambert-Eaton -- small cell lung cancer
Myasthenia gravis -- thymoma

661

ALK

RTK associated with lung adenocarcinoma

662

BCR-ABL

Tyrosine kinase fusion protein associated with CML and some ALL

663

BCL2

Pro-survival/anti-apoptotic associated with follicular and diffuse large B-cell lymphoma

664

BRAF

Serine/threonine kinase associated with melanoma and non-Hodgkin lymphoma

665

c-KIT

Cytokine receptor associated with GIST

666

C-myc

Transcription factor associated with Burkitt lymphoma

667

HER2/neu

Tyrosine kinase associated with breast and gastric carcinomas

668

JAK2

Tyrosine insane associated with chronic myeloproliferative disorders

669

KRAS

GTPase associated with colon, lung and pancreatic cancers

670

L-myc

Transcription factor associated with lung cancers

671

N-myc

Transcription factor associated with neuroblastoma

672

RET

Tyrosine kinase associated with MEN2A and 2B and medullary thyroid cancer

673

APC

Tumor suppressor associated with CRC (esp FAP)

674

BRCA1/BRCA2

Tumor suppressor (DNA repair protein) associated with breast and ovarian cancer

675

CDKN2A

Tumor suppressor (p16, blocks G1-S) associated with melanoma and pancreatic cancer

676

DCC

Tumor suppressor associated with colon cancer

677

DPC4/SMAD4

Tumor suppressor associated with pancreatic cancer

678

MEN1

Tumor suppressor associated with MEN1

679

NF1

Tumor suppressor (Ras GTPase activating protein) associated with neurofibromatosis type 1

680

NF2

Tumor suppressor (Merlin protein) associated with neurofibromatosis type 2

681

PTEN

Tumor suppressor associated with breast, prostate and endometrial cancer

682

Rb

Tumor suppressor (inhibits E2F and blocks G1-S) associated with retinoblastoma and osteosarcoma

683

P53

Tumor suppressor (activates p21 and blocks G1-S) associated with most human cancers, Li Fraumeni Syndrome

684

TSC1

Tumor suppressor (Hamartin protein) associated with tuberous sclerosis

685

TSC2

Tumor suppressor (tuberin protein) associated with tuberous sclerosis

686

VHL

Tumor suppressor (inhibits hypoxia inducible factor 1a) associated with von-Hippel Lindau disease and renal cell carcinoma

687

WT1/WT2

Tumor suppressor associated with Wilms Tumor (nephroblastoma)

688

What malignancies is EBV associated with?

Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, CNS lymphoma in AIDS patients

689

What malignancy is Hpylori infection associated with?

Gastric adenocarcinoma, MALT lymphoma

690

What malignancy is the liver fluke Clonorchis sinensis?

Cholangiocarcinoma

691

With what microbe is cholangiocarcinoma associated?

Clonorchis sinensis

692

What malignancy is infection with schistosoma haematobium associated with?

Squamous cell bladder cancer

693

With what infection is bladder cancer associated?

Schistosoma haematobium

694

Alkaline phosphatase is a serum tumor marker for what malignancies?

Mets to bone or liver
Paget disease of bone
Seminoma

695

Alpha-fetoprotein can be used as a tumor marker for what malignancies?

HCC
Hepatoblastoma
Yolk sac tumor
Mixed germ cell tumor

696

During pregnancy, high levels of AFP indicate what? Low levels?

High -- NTDs, abdominal defects
Low -- Down syndrome

697

BhCG can be used as a tumor marker for which malignancies?

Hyatidiform moles
Choriocarcinoma
Testicular cancer
Mixed Germ Cell Tumor

698

CA15-3/CA27-29 can be serum tumor markers for what malignancy?

Breast cancer

699

CA19-9 can be a serum tumor marker for what malignancy?

Pancreatic adenocarcinoma

700

CA 125 can be used as a serum tumor marker for what malignancy?

Ovarian cancer

701

Calcitonin can be used as a serum tumor marker for what malignancy?

Medullary thyroid carcinoma

702

P-glycoprotein

Serum tumor marker for adrenal cell carcinoma and confers resistance to many chemo agents by pumping out toxins

703

What serum tumor marker is associated with adrenal cell carcinoma?

P-glycoprotein

704

What 4 cytokines are associated with causing cachexia in chronic illness?

TNF
IFNy
IL1
IL6

705

Most carcinomas spread via lymphatics except which 4?

HCC
RCC
Follicular thyroid carcinoma
Choriocarcinoma

706

Volume of distribution formula

Amt of drug in the body/plasma conc of drug

707

Clearance drug formula

(Rate of elimination of drug/plasma drug conc) = Vd x Ke

708

First-order kinetics half-life formula

(0.693 x Vd)/Clearance

709

Loading dose formula

(Cp x Vd)/F

710

Maintenance dose formula

(Cp x CL)/F

711

Therapeutic index formula

LD50/ED50

712

Omalizumab

Recombinant IgG1 antibody that binds to IgE and prevents the interaction with its receptor on mast cells and basophils to treat severe asthma and allergies

713

Wiry curly black hair and petechiae and gingival bleeding

Scurvy

714

Where is collagen hydroxylated?

RER

715

Which 2 amino acids are purely ketogenic and bypass glycolysis to be made into energy?

Lysine
Leucine

716

Which nerve carries parasympathetics to the eye?

CNIII

717

Best medication for treatment-resistant schizophrenia

Clozapine

718

Where does the spinal cord end in adults? Infants?

Adults - inf border of L1
Infants - L2/L3

719

Filum terminale

Extension of the pia mater down past the ending of the spinal cord into a filament that connects the conus medullaris to the posterior coccyx

720

Where does the dura end in the spinal cord?

S2 (fuses with filum terminale)

721

Where is the best place for an LP?

L3-L4 or L4-L5

722

Where does the L4 vertebral body lie and what landmark can be used to identify its location for an LP?

It lies on a line drawn between the highest points of the iliac crests which can be palpated to orient the needle for an LP

723

D-penicillamine

Contains a free sulfhydryl group and can act as a chelators for copper poisoning or Wilson's Disease

724

What drug is used to chelate copper in Wilson's disease?

D-Penacillamine

725

Which nerve causes foot dorsiflexion and toe extension?

Deep peroneal nerve

726

What nerve causes foot eversion?

Superficial peroneal nerve

727

Type II error

Beta --> probability of concluding there is no difference when there is one

728

Type I error

Alpha --> probability of rejecting the null hypothesis and saying an effect exists when it doesn't

729

Of the four conditions associated with tetralogy of fallot, which is the MOST concerning?

RVOT obstruction

730

What are "Tet spells?"

In TOF, dehydration, hyperventilation or an unknown cause leads to a sudden increase in RVOT obstruction leading to more deoxygenated blood shunted across the VSD and into systemic circulation leading to profound cyanosis

731

Which thyroid cancer is associated with increased calcitonin levels?

Medullary thyroid cancer

732

What molecule is used by tumor cells to acquire resistance? What is the mechanism?

P-glycoprotein (acts as an ATP-dependent efflux pump)

733

What is the most common outcome of HepB infection?

Acute hepatitis with complete resolution

734

Buprenorphine

Partial opioid agonist that has low activity (efficacy) but very high binding affinity (potency) to mu receptors essentially making it an antagonist in the presence of full opioid agonists and is used to treat addiction, but can precipitate withdrawal sx

735

Kerley B Lines

Short horizontal lines seen on CXR that represent severe pulmonary edema of the interlobular septa

736

Which exerts a greater effect on cerebral vasodilation, hypoxia or hypercapnia?

Hypercapnia

737

Why are patients hyperventilated in settings of increased ICP?

Decreases pCO2 which causes cerebral vasoconstriction and decreases blood flow, thereby decreasing the ICP

738

Aldesleukin

Recombinant IL2 which increases activity of NK cells and T-cells and is used as immunotherapy against metastatic melanoma and RCC

739

Minute ventilation

Tidal volume x RR

740

What separates the greater and lesser sciatic foramen?

Sacrospinous ligament

741

Which structure occupies most of the space of the greater sciatic foramen?

Piriformis muscle

742

What are the 2 main actions of the piriformis?

Externally rotate an extended thigh
Abducts a flexed thigh

743

Which chemotherapy drug is associated with hemorrhagic cystitis? How can it be prevented?

Cyclophosphamide
Hydration + mesna

744

What drug can be administered alongside chemotherapy to prevent hemorrhagic cystitis?

Mesna

745

Which virus is associated with severe anemia following a minor febrile illness?

parvoB19

746

Which type of emphysema is associated with alpha-1 antitrypsin deficiency and smoking?

Alpha-1 anti-trypsin --> panacinar
Smoking --> centriacinar

747

Which muscles are involved in abducting the humerus?

Supraspinatus initiates the first 10-15* and then the deltoid takes over while the supraspinatus provides stability to the joint

748

What are the effects of DA at low, med and high doses?

Low -- stimulates D1 (increases RBF and GFR)
Med -- stimulates B1 (increases HR, contractility, SBP)
High -- stimulates a1 (vasoconstriction, increases afterload)

749

Triad in Chediak-Higashi syndrome

Immunodeficiency
Albinism
Neurological defects (nystagmus, neuropathies)

750

3 drugs used to treat alcoholism

Disulfiram
Acamprosate
IM naltrexone

751

What is the most common cause of pathological bloody nipple discharge?

Intraductal papilloma

752

At what point along the respiratory tract does the epithelium change? And from what to what?

Terminal bronchioles - goes from pseudostratified ciliated columnar to ciliated simple cuboidal until the alveolar ducts and alveoli

753

At what point in the respiratory tract do Goblet cells disappear?

Smallest bronchi, just before the bronchioles begin

754

When do the lip and palate form?

5-6 weeks

755

What artery does the middle meningeal artery branch from?

Maxillary artery

756

What are the 2 gyri of the occipital lobe that receive visual information?

Cuneus gyrus -- upper retina (lower visual field)
Lingual gyrus -- lower retina (upper visual field)

757

Preferred treatment for blastomycosis

Itraconazole

758

Round yeast with thick walls and broad-based budding

Blastomycosis

759

What is the MOA of fibrates?

Activate PPAR-a which leads to decreased hepatic VLDL production and increased LPL activity to decrease triglyceride levels and increase HDL

760

What are the 3 highest risk factors for coronary heart disease?

Atherosclerosis
Diabetes
Chronic kidney disease

761

Osteocytes are held together via what type of junction?

Gap junctions

762

The median nerve travels between which 2 muscles in the forearm?

Flexor digitorum superficialis
Flexor digitorum profundus

763

Arcuate line

Horizontal line below the umbilicus that demarcates the lower border of the posterior rectus sheath

764

Where do the lung and pleura end at the mid-clavicular line?

Lung - 6th rib
Pleura - 8th rib

765

Where do the lung and pleura end at the mid-axillary line?

Lung- 8th rib
Pleura - 10th rib

766

Where do the lung and pleura end at the paraventricular line?

Lung - 10th rib
Pleura - 12th rib

767

What things does the PAS stain pick up?

Polysaccharides in fungal cell walls
Mucosubstances secreted by epithelial cells
Basement membranes

768

What organism stains with PAS?

Tropheryma whippelii (gram pos actinomycete causing Whipple disease)

769

Ristocetin test

Platelet aggregation test to test for vWF (if vWF is decreased, platelets won't aggregate even in the presence of ristocetin which upregulates GpIb and when normal plasma is added, platelets aggregate)

770

What is the first-line treatment for menorrhagia associated with vWF disease?

OCPs

771

What is the MOST sensitive marker for diagnosing hypothyroidism? Why?

Serum TSH (TSH rises before detectable decreases in T3/T4)

772

What is the BIGGEST difference between OCD and obsessive compulsive personality disorder?

The presence of compulsions performed in response to obsessions occurs ONLY in OCD

773

What is the embryonic derivative of the ductus arteriosus?

Sixth aortic arch

774

What is the embryonic derivative of the aortic arch?

Fourth aortic arch

775

What embryonic structure gives rise to the common carotid?

Third aortic arch

776

Why don't calcium channel blockers cause decreased contractility in skeletal muscle?

Skeletal muscle doesn't rely as heavily on extracellular Ca influx to activate the release of Ca from the sarcoplasmic reticulum (it can release it independently)

777

85% of saccular aneurysms occur in the anterior or posterior circle of Willis?

Anterior

778

An ipsilateral posterior communicating artery aneurysm can cause compression of which nerve?

CNIII

779

Which ribs are considered true ribs? Which are false ribs? Floating ribs?

True ribs --> 1-7
False ribs --> 8-12
Floating ribs --> 11, 12

780

Boerhaave Syndrome

Forceful vomiting and increased intragastric pressure causes a transmural esophageal tear leading to air and fluid leakage into the mediastinum and pleura and can be fatal (Mallory-Weiss tears are only mucosal tears)

781

2 most common cardiac anomalies in Marfan's patients

MVP
Cystic medial degeneration of the aorta causing aneurysm and dissection

782

Most common cause of death in Marfan's patients?

Aortic dissection

783

What are the 4 components of Thayer-Martin agar?

Vancomycin
Colistin
Nystatin
Trimethoprim

784

What are 3 granules contained in basophils?

Heparin
Histamine
SRS-A

785

What finding of the murmur correlates with the severity of AS?

Longer, late-peaking murmur indicates worse AS than a brief, early-peaking murmur

786

What is the accumulation of mutations that causes colonic carcinoma?

Normal colon --> APC inactivation and beta-catenin accumulation --> dysplastic polyp --> K-ras activation --> adenoma --> p53 inactivation --> carcinoma

787

APC

Tumor suppressor on chrome 5 that gets mutated causing beta-catenin accumulation and cell proliferation in the colon leading to polyps

788

KRAS

Proto-oncogene that gets mutated in colonic polyps leading to uncontrolled growth and dysplasia of the polyps into larger adenomas

789

Triad of reactive arthritis

Conjunctivitis
Urethritis
Mono or oligoarticular arthritis

790

What MUST be present to diagnose Hodgkin lymphoma?

Reed-Sternberg cells

791

Where are Reed-Sternberg cells derived from? What disease do they indicate?

Germinal center B cells
Hodgkin lymphoma

792

Which variable is exactly the SAME in both the systemic and pulmonary circulation at rest and exercise?

Blood flow (mL/min)

793

What is a potential side effect of a massive blood transfusion (>5-6 L over 24 hours) and why?

Paresthesias due to hypocalcemia from the citrate in blood transfusions that chelates patient's serum calcium

794

What are the 2 branches of the external iliac artery?

Inferior epigastric (medial)
Deep circumflex iliac (lateral)

795

Periportal pipestem fibrosis

Hepatic schistosomiasis (japonicum, mansoni)

796

Dystonia

Neurological movement disorder with sustained, involuntary muscle contractions that force parts of the body into abnormal and sometimes painful movements (ie spasmodic torticollis, writer's cramp, etc)

797

Spasmodic torticollis

Cervical dystonia causing sustained involuntary neck muscle contraction

798

Blepharospasm

Focal dystonia causing uncontrollable blinking followed by involuntary forceable closure of the eyelids

799

Myoclonus

Sudden, brief and sometimes severe muscle contraction like hiccups and hypnic jerks when falling asleep

800

Hemiballism

Flinging of limbs on one side of the body due to contralateral injury to the subthalamic nucleus

801

What is the most common cause of LV diastolic dysfunction?

Hypertension

802

CNS tumors of neuron origin stain positive for what? What about glial tumors?

Neuronal --> synaptophysin
Glial -->GFAP

803

Etanercept

Fusion protein that links a soluble TNFa to the Fc region of an IgG to act as a decoy receptor for TNFa and reduce concentrations leading to decreased inflammation in RA

804

What is the general equation for calculating velocity of blood flow?

V= Q/A

(Flow/area)

805

What is the general equation for calculating blood flow?

Q= Pressure/Resistance

806

What is Poiseuille's equation for calculating resistance?

R = (8 * viscosity * length)/(pi * radius^4)

807

In the parallel systemic vascular circuit, what happens when an artery is added?

Total resistance decreases

808

What 2 factors cause increased turbulent blood flow?

Decreased viscosity
Increased velocity

809

Capacitance vs elastance

Capacitance = distensibility or stretchability
Elastance = stiffness

810

What basic formula is used to measure compliance or capacitance?

C = V/P

811

On an EKG tracing what corresponds to conduction velocity through the AV node?

PR interval (as AV nodal conduction decreases, the PR interval increases)

812

What is the effect of the SNS and PNS on AV nodal conduction and what would the EKG show?

SNS --> increases conduction, decreased PR interval
PNS --> decreases conduction, increased PR interval

813

What is the capsule of Hib made of? What's its function?

Polyribosylribitol Phosphate (PRP) which binds Factor H that prevents complement binding and resists phagocytosis

814

What type of vaccine is the Hib vaccine?

Conjugate --> PRP conjugated to tetanus toxoid

815

How can a stroke cause seizures?

Ischemic brain region can release excitotoxic neurotransmitters

816

What causes the cells to appear clear in RCC?

High glycogen and lipid content

817

What is the most common site of RCC metastasis?

Lungs

818

GABA is synthesized from what? With what enzyme?

Glutamate via glutamate decarboxylase

819

Cause of helminthic peri-anal itching

Enterobius vermicularis

820

3 commonly used drugs that can cause SIADH

Carbamazepine
Cyclophosphamide
SSRIs

821

Where are ADH and oxytocin synthesized?

Magnocellular neurons in the supraoptic and paraventricular nuclei of the hypothalamus

822

Blockage of what vessel causes an MI that is associated with bradycardia and why?

Right coronary artery (usually causing an inferior MI) because it also supplies the SA and AV nodes, so associated ischemia can cause bradycardia

823

Which cells produce androgen-binding protein and what is the function?

Sertoli cells - concentrates testosterone in the seminiferous tubules to increase spermatogenesis

824

What 3 main reactions are folate derivative involved in?

1. Thymine and purine synthesis
2. Conversion of homocysteine to methionine
3. Generation of one-carbon carriers for methylation

825

Thin actin filaments are bound to __________ in the sarcomere

Z line

826

Where are the myosin filaments located in the sarcomere?

A band

827

In the sarcomere where does myosin anchor?

M line (in the A band)

828

In the sarcomere, which band is made of actin and which is made of myosin?

I band - actin
A band - myosin

829

What is the function of b-hCG?

Secreted from the syncytiotrophoblast to the corpus luteum to continue producing progesterone until the placenta can take over

830

Which 2 prostaglandins cause vasodilation, which 2 cause vasoconstriction?

Vasodilation --> PGI2, PGE2
Vasoconstriction --> PGF2, TXA2

831

What are the 2 most important factors in controlling coronary circulation?

Adenosine
Hypoxia

832

What is the most important regulator of cerebral blood flow?

CO2

833

What are the 3 most important regulators of blood flow to the skeletal muscles during exercise?

Adenosine
Lactate
K+

834

Lynch Syndrome/HNPCC

AD defect in MSH1 and MLH1 which code for the MutS and MutL proteins involved in DNA mismatch repair

835

An error in eukaryotic DNA Pol causing mismatches occurs every how many base pairs?

10^6

836

What is the acid-base status of someone with a pulmonary embolus

Respiratory alkalosis due to hyperventilation (high pH, low CO2, low O2, normal bicarb until 48 hours and then decreased bicarb)

837

Vertebral level where the SMA leaves the aorta

L1

838

Vertebral level of the transverse duodenum

L3

839

Which murmur is heard loudest when the patient sits up and forward and at end-expiration?

Aortic regurgitation

840

What is a side effect of opioids that could present as severe RUQ pain?

Mu opioids cause contraction of smooth muscle cells in the Sphincter of Oddi leading to spasm and increased common bile duct pressures and can lead to biliary colic

841

What is the age cutoff for precocious puberty in white girls?

Age 7

842

What type of reaction is caused by scabies?

Type IV hypersensitivity

843

How is scabies diagnosed?

Presence of mites, ova and feces in skin scrapings viewed under light microscopy

844

The ureters course from the renal pelvis __________ to the gonadal vessels, _________ to the iliacs and _____________ to the uterine artery in females.

Posterior
Anterior
Posterior

845

What is the MAC? What 2 factors does it depend on?

Minimal alveolar concentration that measures the potency of an inhaled anesthetic (lower the MAC, higher the potency) and depends on body temperature and age.

846

What are the 3 D's of botulinum toxicity?

Diplopia
Dysphagia
Dysphonia

847

Where can MRSA normally colonize a host?

Nasopharynx

848

What is the MCC of SCID? Second MCC?

X-lined recessive mutation
Adenosine deaminase deficiency

849

What are Rh antigens?

Non-glycosylated transmembrane proteins on the surface of RBCs

850

What is Rhogam and when is it administered?

Anti-Rh(D) IgG antibodies from donor plasma and is given to ALL Rh neg pregnant woman at 28 weeks AND immediately postpartum

851

What is the immediate treatment of a panic attack? What is the best long-term treatment of panic disorder?

Immediate --> benzo
Long-term -->SSRI or SNRI

852

Why do patients with IPF have higher than normal expiratory flow rates?

The thickened and fibrotic interstitium causes increased radial traction, pulling apart the bronchioles causing decreased airflow resistance and increased expiratory flow

853

2 important S-100 positive tumors

Schwannoma
Melanoma

854

Where is elastase produced in the lungs? What keeps it from normally destroying parenchyma?

Macrophages and neutrophils
A1-antitrypsin (inhibits PMN elastase)
Tissue inhibitors of metalloproteinases/TIMPs (inhibit MO elastase)

855

Which artery supplies the ACL?

Middle geniculate artery

856

What does a muscle biopsy of polymyositis show?

Endomysial infiltrate of macrophages and CD8 T cells with areas of patchy necrosis

857

Formula for bioavailability

AUCoral/AUCiv

858

What does an ischemic stroke first look like on CT?

Hypodense with edema and loss of distinction of the gray-white matter junction

859

What is the pathological hallmark of ischemic infarct within the first 48 hours?

Red neurons (irreversible neuron damage)

860

How many pharyngeal/branchial arches are there? All but which one form structures that remain in the adult?

6 arches, 5 regresses

861

Treacher-Collins Syndrome

Abnormal development of 1st and 2nd pharyngeal arches leading to severe craniofacial abnormalities, feeding difficulties, abnormal or absent ossicles causing conductive hearing loss

862

What are the 4 locations that optic tract fibers project to?

1. Lateral geniculate nucleus (then to occipital lobe)
2. Superior colliculus (reflex gaze)
3. Pretectal area (light reflex)
4. SCN (Circadian rhythms)

863

What are the 4 dopaminergic pathways?

1. Mesocortical (VTA to cortex)
2. Mesolimbic (VTA to nucleus accumbens)
3. Nigrostriatal (Substantia nigra to caudate/putamen)
4. Tuberoinfundibular (Hypothalamus to pituitary)

864

What causes the positive and negative symptoms of schizophrenia?

Positive --> hyperactive mesolimbic DA pathway
Negative --> hypoactive mesocortical DA pathway

865

Etanercept

Fusion protein of Fc IgG1 and TNFreceptor2 that acts as a decoy receptor for TNFa and can be used as an anti-inflammatory in severe RA

866

Cavernous hemangioma

Sporadic or familial vascular malformations consisting of clusters of dilated, thin-walled capillaries that occur within the brain parenchyma and can cause seizures, progressive neuro deficits and bleed leading to intraparenchymal hemorrhage

867

Tidal Volume

Volume inspired or expired with each normal breath

868

Inspiratory Reserve Volume

Volume that can be inspired above the normal tidal volume and is frequently used during exercise

869

Expiratory reserve volume

Volume that can be expired after the expiration of a normal tidal volume

870

Which lung volumes and capacities CANNOT be measured by spirometry?

Residual volume
FRC (ERV + RV)
TLC

871

Residual volume

Volume that can be expired after a maximal expiration

872

What is the difference between anatomic and physiologic dead space?

Anatomic --> dead space in the conducting airways
Physiologic --> volume of the lungs that doesn't gas exchange

873

Physiologic dead space calculation

Vd = Tidal volume x (PAco2 - PEco2/PAco2)

874

Minute ventilation

Tidal volume x breaths/min

875

Alveolar ventilation equation

(Tidal volume - dead space) x breaths/min

876

Inspiratory capacity

Tidal volume + inspiratory reserve volume (total amt that can be inspired)

877

Functional reserve capacity

Expiratory reserve volume + residual volume (amt that can be expired after a tidal volume)

878

Forced vital capacity or vital capacity

Tidal volume + IRV + ERV (volume that can be forcibly expired after maximal inspiration)

879

Total lung capacity

Tidal volume + IRV + ERV + RV (volume in lungs after a maximal inspiration)

880

What is a normal FEV1/FVC ratio?

80% or 0.8

881

What 3 muscles are used during inspiration?

Diaphragm
External intercostals
Accessory muscles

882

What muscles can be used during expiration if needed?

Abdominal muscles
Internal intercostals

883

Formula for compliance

C= V/P

884

Transmural pressure

Alveolar pressures - intrapleural pressure

885

Which cells make surfactant?

Type II pneumocytes

886

What reflects mature fetal lungs?

Amniotic fluid sample of lecithin:sphinomyelin ratio of at least 2:1

887

Where is resistance to airflow HIGHEST along the respiratory tract?

Medium sized bronchi

888

What are the alveolar pressures and pleural pressures at rest?

Alveolar - 0 (same as atmosphere)
Pleural - slightly negative

889

At what point during the breathing cycle is the intrapleural pressure POSITIVE?

Only during a forced expiration

890

Why do patients with COPD breathe with pursed lips?

Pursed lips causes increases resistance to air flow and decreases the pressure gradient the causes airway collapse with expiration

891

What is the atmospheric fractional concentration of O2?

21% (0.21)

892

What is the PO2 of inspired air in the trachea?

150 mmHg

893

Why is the PaO2 slightly lower than the PAO2?

About 2% of the cardiac output is physiologically shunted away from the pulmonary circulation so venous blood mixes with the arterial blood

894

Dissolved gas concentration formula

Pgas x solubility of the gas

895

Why is the diffusion decreased in BOTH pulmonary fibrosis and emphysema?

IPF --> thicker alveolar walls increases distance for diffusion
Emphysema --> destruction of some alveoli decreases surface area for diffusion

896

What 2 markers are used to screen for NTDs?

Serum alpha-fetoprotein and acetylcholinesterase

897

What is the MOST sensitive strategy for screening for malabsorption disorders?

Testing for fat malabsorption via stool Sudan III stain

898

How many calories are in a gram of protein, carbs, fat and ethanol?

4 in proteins, carbs
9 in fat
7 in ethanol

899

Conn Syndrome

Primary hyperaldosteronism caused by an adrenal adenoma

900

Strongest hip flexor muscle

Iliopsoas

901

Treatment of status epilepticus

IV benzo (acutely) + IV phenytoin

902

What causes the tissue damage and formation of pulmonary abscesses?

Lysosomal enzymes released from PMNs and macrophages

903

Lesion of what nerve can result in vertical diplopia that is especially worse with looking down (during reading or walking downstairs)?

Trochlear nerve (CNIV)

904

MCC cardiac malformation in Turner Syndrome

Bicuspid aortic valve

905

Which 3 cytokines mediate the systemic inflammatory response and stimulate hepatic secretion of acute-phase reactants?

IL1
IL6
TNFa

906

High levels of what acute-phase reactant causes erythrocytes to sediment (ESR) and is a marker of inflammation?

Fibrinogen

907

What should be monitored before and after removal of a complete mole and why?

B-hCG because an increase or plateau can signify malignant transformation of the tissue to an invasive mole or choriocarcinoma

908

SPINK1

Protein secreted by pancreatic acini that inhibits trypsin and prevents premature pancreatic enzyme cascade and autodigestion of pancreas

909

Kehr Sign

Referred shoulder pain due to peritoneal irritation (from hemoperitoneum or peritonitis)

910

3 sensory regions of the phrenic nerve

Pericardium
Mediastinal pleura
Diaphragmatic peritoneum (referred pain to C3-C5 shoulder region)

911

5 receptors that stimulate vomiting reflex in the area postrema and adjacent nuclei

M1
D2
H1
5-HT3
Neurokinin1

912

Essential tremor

Familial tremor (AD inheritance) that worsens with movement and improves with alcohol consumption and is treated with propranolol

913

Treatment for essential tremor

Propranolol

914

Which class of inhaled anaesthetics is associated with severe hepatotoxicity and hepatitis?

Halogenated inhaled anaesthetics like halothane and the "fluranes"

915

Optic neuritis

Monocular visual loss with pain on eye movement and an afferent pupillary defect commonly seen as presenting symptoms in MS

916

What is a rare side effect of starting warfarin therapy that presents with large sharply demarcated purpuric lesion?

Warfarin-induced skin necrosis in a patient with underlying Protein C or S deficiency

917

Which 2 factors are depleted FIRST when starting warfarin therapy?

Factor VII
Protein C

918

What are 2 congenital Syndromes that can prolong QT and how are they distinguished?

1. Jervell and Lange-Nielsen syndrome (AR + sensorineural deafness)
2. Romano-Ward Syndrome (AD and no deafness)

919

What 2 regions of the kidney are MOST susceptible to ischemic injury leading to ATN?

Proximal tubule
Thick ascending limb
(Use the most energy)

920

What type of cast is pathognomonic for ATN?

Granular pigmented casts (muddy brown casts)

921

Presence of granular pigmented or muddy brown casts in urine suggests?

ATN

922

What is the MCC of acute kidney injury in hospitalized patients?

Ischemic ATN due to decreased renal perfusion

923

Which ligament arises from the anterolateral surface of the medial condyle of the femur?

PCL

924

Which ligament attaches to the posterior medial side of the lateral femoral condyle?

ACL

925

Which type of vessel is MOST susceptible to the action of nitroglycerin?

Large veins

926

Why do reticulocytes look blue on staining, whereas mature RBCs don't?

Reticulocytes have lost their nucleus but retain a meshwork of rRNA which appears blue on Wright-Giemsa stain

927

Germ layer: salivary, sweat and mammary glands

Surface ectoderm

928

Germ layer: Anterior pituitary and posterior pituitary

Anterior --> Rathke's pouch (surface ectoderm)
Posterior --> Neural tube

929

Germ layer: lens, cornea, retina

Lens --> surface ectoderm
Cornea --> surface ectoderm
Retina --> neural tube

930

Germ layer: inner and middle ear

Inner ear --> surface ectoderm
Middle ear --> endoderm

931

Germ layer: epidermis

Surface ectoderm

932

Germ layer: olfactory, nasal and oral epithelium

Surface ectoderm

933

Germ layer: brain

Neural tube

934

Germ layer: spinal cord

Neural tube

935

Germ layer: Pineal gland

Neural tube

936

Germ layer: ganglia

Neural crest

937

Germ layer: Schwann cells

Neural crest

938

Germ layer: meninges

Neural crest

939

Germ layer: aorticopulmonary septum

Neural crest

940

Germ layer: endocardial cushions

Neural crest

941

Germ layer: branchial/pharyngeal arches

Neural crest

942

Germ layer: melanocytes

Neural crest

943

Germ layer: adrenal cortex and medulla

Cortex --> mesoderm
Medulla --> neural crest

944

Germ layer: skull bones

Neural crest

945

Germ layer: cardiac and smooth muscles

Mesoderm

946

Germ layer: skeletal muscle

Mesoderm

947

Germ layer: CT, bone and cartilage

Mesoderm

948

Germ layer: serosa

Mesoderm

949

Germ layer: CV system

Mesoderm

950

Germ layer: blood and lymph

Mesoderm

951

Germ layer: spleen

Mesoderm

952

Germ layer: kidney

Mesoderm

953

Germ layer: ureters and urethra

Ureters --> mesoderm
Urethra --> endoderm

954

Germ layer: GI tract

Endoderm

955

Germ layer: liver and pancreas

Endoderm

956

Germ layer: lungs

Endoderm

957

Germ layer: thymus

Endoderm

958

Germ layer: parathyroids

Endoderm

959

Germ layer: bladder

Endoderm

960

When during development does gastrulation occur? What initiates it?

Week 3
Formation of the primitive streak (caudal --> cranial)

961

Interscalene nerve block is used for what and is adversely associated with paralysis of what?

Regional anesthesia used for shoulder and upper arm procedures by blocking brachial plexus roots and trunks, but transient ipsilateral diaphragmatic paralysis can occur as C3-C5 nerve fibers also run through the interscalene sheath

962

Which drugs are the best to give to a pregnant woman with a DVT?

Low molecular weight heparins like enoxaparin

963

What enzyme metabolizes steroids, alcohols and toxins but also converts pro-carcinogens into carcinogens?

Microsomal monooxygenase

964

Microsomal monooxygenase

Hepatic enzyme that metabolizes steroids, alcohols and toxins but also converts pro-carcinogens into carcinogens

965

Ovarian failure prior to what age is considered premature ovarian failure?

Before 35

966

Buspirone

Partial 5-HT1a receptor agonist used to treat generalized anxiety disorder and has a slow onset of action

967

What are 2 causes of concentric LVH?

Pressure overload --> chronic HTN, aortic stenosis

968

What are 3 causes of eccentric LVH?

Volume overload--> aortic or mitral regurgitation, MI, dilated cardiomyopathy

969

What type of enzyme is telomerase?

Reverse transcriptase (makes TTAGGG repeats on 3' end of chromosomes using RNA template)

970

Which 2 second generation antipsychotics are associated with the highest risk of metabolic adverse effects?

Olanzapine
Clozapine

971

What are the 2 most common pathologic lesions seen in Alzheimer's disease brains?

1. Extracellular AB plaques surrounded by dystrophic neuritis
2. Intracellular neurofibrillary tangles of hyperphosphorylated Tau protein

972

Spinal Muscular Atrophy

Mutation in SMN1 gene (survival motor neuron gene) which encodes a protein involved in the assembly of snRNPs in lower motor neurons which causes impaired spliceosome function and degradation of anterior horn cells

973

What is the ratio of fat to hematopoietic cells in the normal bone marrow?

1:1

974

What is the primary effector cell causing contact dermatitis in response to poison ivy?

CD8 T cells

975

Calcaneovalgus position

Foot is dorsiflexed and everted (due to tibial nerve injury)

976

Which 3 muscles are involved in plantarflexion?

Gastrocnemius
Soleus
Plantaris muscles

977

Which muscles invert the foot?

Tibialis posterior and anterior

978

Which muscles evert the foot?

Fibularis
Extensor digitorum longus

979

What cell type does renal clear cell carcinoma originate from?

Proximal tubule epithelial cells

980

What causes the cells to appear clear in renal clear cell carcinoma?

Excess intracellular glycogen and lipids

981

Which type of pneumonia is associated with complement-mediated intravascular hemolytic anemia?

Mycoplasma pneumoniae

982

What are 3 causes of increased bicarbonate secretion? From where?

1. Tactile stimulation of duodenum from food (Brunner's glands)
2. Increased PNS activity following meals (Brunner's glands)
3. Presence of gastric acid in duodenum increases release of secretin (Brunner's glands and pancreatic juices)

983

What does the EEG show in patients with absence seizures?

Generalized 3.0 Hz spike wave complexes with normal background activity

984

Where is iron absorbed?

Duodenum and proximal jejunum

985

Receptors that use IP3/PKC pathway

Alpha1, M1, M3, V1 (vasopressin), H1 (histamine), oxytocin, AngII, TRH, GnRH

986

What are the 3 components of a craniopharyngioma?

1. Solid (tumor cells)
2. Cystic ("machinery oil liquid")
3. Calcified

987

Infusion of what can actually precipitate Wernicke encephalopathy and why?

Glucose without thiamine because thiamine is important in glucose metabolizing pathways, so infusing glucose in a thiamine-deficient patient can precipitate encephalopathy

988

What structure limits the ascent of a horseshoe kidney?

IMA

989

Which 2 walls of the orbit are most prone to fracture?

Medial and inferior

990

Varenicline

Partial agonist at the a4b2 nicotinic ACh receptor in the CNS that competes with nicotine and is used to decrease nicotine withdrawal symptoms and help decrease dependence

991

3 most common causes of pericarditis

MI
Rheumatic fever
Uremia

992

Interruption of cerebral blood supply for how long can cause loss of consciousness? Irreversible injury?

LOC after 5-10 seconds
Irreversible injury after 4-5 minutes

993

Which cells are MOST susceptible to ischemic brain injury?

Pyramidal cells of hippocampus
Purkinje cells of cerebellum

994

Which disease is associated with cystic degeneration of the putamen?

Wilson's disease

995

Which 2 cell types produce the most heme?

Hepatocytes
Erythrocyte precursor cells

996

What are the 2 nerve plexi of the intestinal wall and what layers are they in?

Meissner (submucosa)
Auerbach/Myenteric (Muscularis propria)

997

What causes a porcelain gallbladder? It increases the risk of what condition?

Chronic cholecystitis leads to deposition of calcium salts in the muscularis or mucosa. It increases the risk of adenocarcinoma of the gallbladder.

998

What are the 2 mechanisms of isoniazid resistance?

1. Decreased bacterial expression of the catalase-peroxidase enzymes that is required for isoniazid activation.
2. Modification of the protein target for the binding site of isoniazid.

999

Which antibiotic is associated with serotonin syndrome?

Linezolid

1000

What is the diagnostic criteria for premature ejaculation?

Ejaculation within ONE minute of penetration most of the time for at least 6 months

1001

What drug can be used to treat premature ejaculation?

SSRIs

1002

What condition is associated with a "ground glass" appearance in hepatocytes?

Hep B

1003

Councilman bodies

Deeply eosinophilic globules that are shrunken, apoptotic hepatocytes seen in many liver diseases

1004

Mallory bodies

Clumps of eosinophilic intracytoplasmic inclusions in hepatocytes made of tangled intermediate filaments and mark alcoholic steatohepatitis

1005

NE extravasation

Leakage of an NE infusion out of the vein into surrounding tissue causing alpha1mediated vasoconstriction, pallor and is reversed by injecting phentolamine

1006

Gottron papules

Red or violaceous flat-topped papules over joints and bony prominences especially on hands associated with dermatomyositis

1007

Heliotrope rash

Red or violaceous rash on upper eyelids and periorbital skin in dermatomyositis

1008

What is the MOST specific test for dermatomyositis?

Anti-Jo1 antibodies and muscle biopsy

1009

Kallmann Syndrome

Mutations in KAL1 or FGFR1 leading to a failure of migration of GnRH neurons from olfactory placode to hypothalamus leading to central hypogonadism, anosmia, delayed puberty and other midline defects

1010

What is the first sign of puberty in boys? Girls?

Boys --> testicular enlargement
Girls --> breast enlargement

1011

What is considered delayed puberty in boys and girls?

Absence or incomplete development of secondary sex characteristics by age 14 in boys and age 12 in girls

1012

What are the genital lesions in primary, secondary and tertiary syphillis?

Primary --> painless chancre
Secondary --> condylomata lata
Tertiary --> Gumma

1013

At what stage of syphillis does the palms and soles rash occur?

Secondary stage

1014

At what stage of syphillis do aortic and cardiac manifestations occur?

Tertiary stage

1015

At what stage of syphillis do neuro symptoms like tabes dorsalis and subacute meningoencephalitis occur?

ANY stage

1016

What are the 2 classes of gastric adenocarcinoma?

Signet-ring carcinoma
Intestinal-type adenocarcinoma

1017

What are 2 causes of black pigmented gallstones?

1. Chronic hemolysis
2. Increased enterohepatic cycling of bilirubin (ileal diseases)

1018

What is the main cause of brown pigmented gallstones?

Biliary tract infection usually from Ecoli or liver fluke (Clonorchis sinensis)

1019

Plummer-Vinson Syndrome

Iron-deficiency anemia, dysphagia and esophageal web

1020

What is the difference between edema and angioedema of the skin?

Edema is restricted to the superficial dermis, and angioedema is present in the deep dermis and subQ

1021

What nationality is associated with classic PKU?

Scandinavian

1022

Which cranial nerve exits the brainstem at the level of the middle cerebellar peduncle?

CNV

1023

What are the 4 layers penetrated during an emergency cricothyrotomy?

Skin --> superficial cervical fascia (SubQ fat and platysma) --> investing, pretracheal layers of deep cervical fascia --> cricothyroid membrane

1024

What is the most common malignancy associated with asbestos exposure?

Bronchogenic carcinoma

1025

Where is type 1 collagen located?

Bone, teeth, ligaments, skin, sclera

1026

Osteogenesis imperfecta

AD disease of Type 1 collagen leading to brittle bones, deformed teeth, blue sclera, hearing loss and easy bruising

1027

What are the 2 main components of bone matrix?

1. Inorganic hydroxyapatite crystals
2. Organic type 1 collagen

1028

What are the 2 most common indications for clozapine treatment?

1. Treatment-resistant schizophrenia
2. Schizophrenia with suicidality

1029

Leuprolide

GnRH analog that is administered in a pulsatile fashion to act as a GnRH analog and administered in a continuous fashion to act as a GnRH antagonist like in prostate cancer

1030

Which section of the nephron is impermeable to urea?

Thick ascending LOH, DCT and CD

1031

Where does Ca absorption take place in the nephron and how?

PCT --> passively
Ascending LOH --> passively
DCT and CD --> actively stimulated by PTH

1032

What is the flow of creatinine through the nephron?

Freely filtered through glomerulus with a SMALL amount being secreted by PCT and all of it getting excreted

1033

What is the path of glucose through the nephron?

Filtered through the glomerulus and ALL reabsorbed in the PCT as long as the transport maximum isn't reached

1034

What is the path of PAH in the nephron?

Some filtered through glomerulus and MOST is completely secreted by the PCT with NO absorption and is dependent on RPF

1035

What causes the sickling of the RBCs in SS anemia?

Glu to Val substitution causes change from a charged to nonpolar amino acid and the B globin chain forms hydrophobic interactions with the alpha chain of another Hgb and promotes aggregation that leads to eventual formation of fibrous polymers of Hgb and sickling (esp under hypoxic, acidic or dehydrated states)

1036

Injury to what nerve and muscle causes a winged scapula?

Serratus anterior, long thoracic nerve

1037

Which 2 muscles abduct the arm to the horizontal position, and which 2 muscles are required to finish the abduction?

Deltoid and supraspinatus
Serratus anterior and trapezius rotate glenoid superiorly allowing for full abduction

1038

Where does the long thoracic nerve originate from?

C5-C7 nerve roots (brachial plexus)

1039

Penetrating trauma, chest tube insertion or axillary lymph node dissection can cause injury to what nerve?

Long thoracic nerve

1040

To produce stable angina, the fixed atheromatous plaque must obstruct what percent of the lumen?

At least 75%

1041

What step of the TCA cycle makes GTP?

Succinyl-CoA synthetase converting succinyl-CoA to succinate

1042

Which 3 enzymes in the TCA cycle produce NADH?

Isocitrate dehydrogenase
A-ketoglutarate dehydrogenase
Malate dehydrogenase

1043

Which enzyme in the TCA cycle produces FADH2

Succinate dehydrogenase

1044

Which enzyme in the TCA cycle produces CO2?

Isocitrate dehydrogenase

1045

What are 3 key differences that can help differentiate Lambert-Eaton from MG?

1. Hyporeflexia or areflexia
2. Autonomic symptoms
3. Incremental response to repetitive stimulation

1046

ACE inhibitors cause dilation of which arteriole?

Efferent

1047

What is the power of a study?

(1-B) which represents the study's ability to detect a difference when one truly exists where B is the probability of committing a type II error (failure to reject the null when it is truly false and missing a true relationship)

1048

Where is the most common PRIMARY location of a carcinoid syndrome tumor?

Ileum

1049

How does acetazolamide treat glaucoma?

Blocks the bicarbonate formation and therefore the aqueous humor production

1050

The most common nosebleeds arise from where?

Kiesselbach plexus (watershed area of the anteriorinferior nasal septum)

1051

What 3 major vessels anastomose in Kiesselbach plexus in the nasal septum?

1. Anterior ethmoidal artery
2. Sphenopalatine artery
3. Superior labial artery (from the facial artery)

1052

In which meatus are nasal polyps most commonly located?

Middle meatus

1053

Through which meatus do tears drain?

Inferior meatus (via nasolacrimal duct)

1054

Where do osmotic diuretics like mannitol work in the kidney?

PCT and descending LOH

1055

Which class of diuretics are most potent?

Loop diuretics

1056

How do the 2 classes of K-sparing diuretics work?

1. Amiloride/triamterene directly block ENaC on principal cells
2. Spironolactone/eplerenone competitively inhibit the aldosterone receptor causing downregulation of ENaC and basolateral Na/K pumps

1057

How does uremia cause a coagulopathy?

Uremia in patients with renal failure causes toxic buildup of metabolites that results in a qualitative platelet disorder with normal PT, PTT and number of platelets but an increased bleeding time

1058

Tesamorelin

GHRH analog used to treat HIV-associated lipodystrophy

1059

Annular pancreas

Failure of the ventral pancreatic bud to rotate around to fuse with the dorsal pancreatic bud so it surrounds the second part of the duodenum and can cause obstruction and pancreatitis

1060

Which antibody is BEST at binding and activating complement and why?

IgM because it circulates as a pentamer and C1 must bind the Fc portions of at least 2 different antibodies to become activated and initiate the classical complement cascade

1061

3 most common cancers in men

1. Prostate
2. Lung
3. Colon

1062

What are the 2 ionic effects of opiates?

1. Block presynaptic Ca channels (block NT release) on the primary afferent neuron in the dorsal horn
2. Enhance postsynaptic K efflux (cause hyperpolarization) of the second order neuron leaving the dorsal horn

1063

What is the receptor type used in mu, delta and kappa receptors?

Gi

1064

IFNB