Step 1 All content

Question 1

Sudan III staining

Answer 1

Checks the stool for presence of fat globules indicating steatorrhea

Question 2

Prader willi genetic error that occurs

Answer 2

2 copies of a chromosome from the mother (fathers copy is lost) Pray for Willi he’s only 15 but short fat and dumb

Question 3

ankylosing spondylitis HLA assoc

Answer 3

HLA-B27

Question 4

Papillary Carcinoma of thyroid

Answer 4

P’s. Psamoma bodies, Prevalent, palpable nodes.
Also Orphan annie nuclei.

RET/PTC and BRAF mutations

Question 5

Leuprolide and hormones as function of time

Answer 5

First stimulates GNRH but once chronically stimulated it actually therapeutically decreases FSH and LH

Question 6

Zones of adrenal gland

Answer 6

G- aldosterone
F- cortisol
R- Androgens
medulla- chromaffin cells catecholamines

Question 7

thrombo thrombocytopenic purpura symptom pentad and issue

Answer 7

fever, Microangiopathic hemolysis, neuro, thrombocytopenia and renal issues
can be older pt

ADAMS 13 a metalloprotease that usually degrades vWF

Question 8

most common embryonic structure that leads to congenital diaphragmatic hernia

Answer 8

pleuroperitoneal folds

Question 9

I cell Disease

Answer 9

bilateral, hip abnormalities, corneal clouding, course facial features. lysomal disease where an important phosphorylation enzyme (N-acetylglucosaminyl-1-phosphotransferase)

Question 10

Kaposi Sarcoma

Answer 10

HSV 8 often GI bleeds or hematochezia involvement

Question 11

measles distinguishing features

Answer 11

rash starts on the neck, koplik spots and conjunctivitis

Question 12

Scurvy biochem issue

Answer 12

proline and lysine of collagen are not hydroxylated in the endoplasmic reticulum

Question 13

Absolute risk

Answer 13

AR = a/(a+b) - c/(c+d)

Question 14

Albinism biochem defect and embryologic issue

Answer 14

tyrosinase deficiency. melanocytes are derived from neural crest cells

Question 15

Mechanism of isoniazid resistance

Answer 15

less KatG, so the catalase peroxidase enzymes need to activate drug are not expressed

Question 16

receptor found on all T cells that is often targeted by anti rejection meds

Answer 16

CD3

Question 17

CD16

Answer 17

natural killer cells

Question 18

hemolytic anemia and gallstone type?

Answer 18

UNconjugated bilirubin stones. (liver overwhelmed)

Question 19

ERBB2 (formerly HER2) drug

Answer 19

Trastuzumab, watch for cardiotoxicity

Question 20

Thiazide diuretics common side effects

Answer 20

HyperGLUC (glucose, lipids, uric acid, calcium)

Question 21

What does the axillary nerve branch from?

Answer 21

posterior cord

Question 22

complication of tumor lysis syndrome

Answer 22

arrhythmia

Question 23

Atypical cells in mono

Answer 23

CD8 T cells have abnormally abundant cytoplasm

Question 24

RNA virus mnemonic

Answer 24

I went to a RETRO TOGA party, and drank FLAVored CORONA and ate CALIfornia PICkles. +reo virus which is only Ds RNA virus.

Question 25

non-Enveloped viruses

Answer 25

DNA- PAPP | RNA- CPR + hepevirus

Question 26

what neurotransmitter helps you sleep

Answer 26

acetylcholine in reticular formation

Question 27

NF1 gene and symptoms

Answer 27

NF-1 tumor suppressor gene on chromosome 17q | cafe-au-lait, neurofibromas, lisch nodules. Autosomal dominant

Question 28

NF2 gene

Answer 28

misprediction of the gene product merlin. | Schwannomas

Question 29

mom introduces juice to infant then lethargy

Answer 29

aldolase B deficiency in fructose intolerance. fructose-1-phosphate inhibits gluconeogenesis leading to hypoglycemia (All die, more severe)

Question 30

MEN syndromes inheritance

Answer 30

all are autosomal dominant

Question 31

lead poisoning treatment

Answer 31

dimercaprol

Question 32

krugenberg tumors

Answer 32

gastric tumors that met to the ovaries. associated with supraclavicular lymphadenopathy

Question 33

what transports botulism towards cell center

Answer 33

dynein

Question 34

polyarteritis nodosa path?

Answer 34

transmural inflammation and fibrinoid necrosis. | and beads on a string

Question 35

yellow fever post mortem biopsy finding and symptoms

Answer 35

High AST, bloody emesis, jaundice Counselman bodies (they are degenerated eosinophils)

Question 36

CML genetics

Answer 36

Philadelphia chromosome 9:22 translocation that turns on a tyrosine kinase

Question 37

Ewing Sarcoma genetics

Answer 37

11:22 overactive transcription factor

Question 38

Herpes zoster/CMV path

Answer 38

Cowdry A inclusion bodies

Question 39

Call-exner bodies

Answer 39

granulosa cell tumors

Question 40

Mallory bodies

Answer 40

alcoholic hepatitis. Damaged intermediate filaments

Question 41

Reinke crystals and what are they

Answer 41

Leydig cell testicular cancer. Eosinic inclusions

Question 42

G6PD inheritance

Answer 42

XR but can display lyonization

Question 43

Horshoe kidney gets tuck on what

Answer 43

Inferior mesenteric

Question 44

anaphylaxis immune elements

Answer 44

IgE with bound C3a C5a on mast cells causing histamine release

Question 45

Signs of hydrops fetalis (Rh incompatibility)

Answer 45

purpura, thickened placenta, hepatosplenomegaly with ascites, dead baby

Question 46

benzo overdose trx

Answer 46

flumazenil competitive inhibition so shifts benzo dose response curve right.

Question 47

Distinguishing between Barter and Gitlemans

Answer 47

Calcium is high in Bartter and low in Gitelman

Question 48

ethylene glycol overdose trx

Answer 48

fomepizole

Question 49

Alport's defect and inheritance

Answer 49

type 4 collagen. Cant hear cant see cant pee. x-linked dominant

Question 50

Goodpasture

Answer 50

anti basement membranes specifically against alpha 3 chain of type 4 collagen. Cough hemoptysis and renal loss of proteins and red cells

Question 51

cholinergic excess ( organophosphate poisoning ) trx

Answer 51

atropine in organophosphate poisoning

Question 52

difference between repression and suppression

Answer 52

unaware of repression. Consciously suppress

Question 53

Job syndrome

Answer 53

Defective helper T cells (Th17) cant make tnf-gamma to recruit neutrophils. recurrent staph accesses. retained teeth. High IGE and dermatologic issue.

Question 54

Midline midbrain localization

Answer 54

Motor pathway (corticospinal) CL Medial Lemniscus CL MLF- IL Motor nerve nucleus- IL 3,4,6,12

Question 55

Lateral midbrain localization

Answer 55

Spinocerebellar IL spinothalamic CL Sensory of CN5 IL Sympathetic IL

Question 56

Diuretics in kidney stone Hx + HTN

Answer 56

Thiazides

Question 57

really quick rhabdo and cramping with exercise in a young pt, biochem?

Answer 57

McArdle disease; myophosphorylase def occurs in cytosol

Question 58

AML with Auer rods genetics

Answer 58

T (15;17) translocation

Question 59

Hep C med with tons of side effects including depression

Answer 59

peginterferon alpha

Question 60

how does hodgkin lymphoma evade immune system?

Answer 60

downregulates MHC1

Question 61

Neuro reflex roots

Answer 61

``` Bicep- C5,C6 brachioradialis- C6 tricep- C7 Patellar- L2,4 ankle- S1 Cremasteric- L1, L2 Anal wink- S3, S4 ```

Question 62

how does exercise lower glucose?

Answer 62

increased expression and transport of glut 4 to the surface

Question 63

Desmopressin hematological use

Answer 63

increases vwf and VIII (8) from Weibel Palade bodies

Question 64

if a mixing study does not correct bleeding?

Answer 64

usually an antibody against something

Question 65

Bernard Soulier vs Glanzman thrombasthenia

Answer 65

Bernard Soulier- low Gp1b, large platelets | Glanzman - no platlet clumbing low GPIIb/IIIa

Question 66

T(12:21) and T(9:22)

Answer 66

ALL T(12:21) Better prognosis most common T(9:22) Worse prognosis. less common

Question 67

CD20, CD23 and CD5 positive B cells

Answer 67

Chronic Lymphocytic Leukemia | Small Lymphocytic Lymphoma

Question 68

TRAP positive and treatment

Answer 68

Hairy Cell Leukemia, Cladribine or pentostatin

Question 69

what is APL?

Answer 69

AML t(15:17) translocation associated with auer rods and myeloperoxidase positive. Responds to Vit A and arsenic

Question 70

t(9:22)

Answer 70

CML BCR-ABL

Question 71

JaK2 mutations cancer?

Answer 71

Polycythemia vera

Question 72

t(8:14)

Answer 72

bukitt (burk8) lymphoma: C-MYC overexpression (causes transcription factor overactivation

Question 73

BCL2 and BCL6 mutations

Answer 73

Diffuse large cell B-cell lymphoma

Question 74

t(14;18)

Answer 74

Follicular lymphoma. BCL-2 overexpression

Question 75

t(11;18)

Answer 75

Marginal zone lymphoma assoc with chronic inflammation.. AYY (11) I'm Aching (18)

Question 76

t(11:14) and cell cycle area

Answer 76

Mantel cell lymphoma. Increase in Cyclin D1 and skips G1-S checkpoint

Question 77

Collagen types and associated diseases

Answer 77

type I: Osteogenesis imperfecta type 3: Ehlers Danlos, type 4: Alport, Goodpasture

Question 78

heme synthesis what defects mitochondria vs cytoplasm

Answer 78

Mitochondria- sideroblastic anemia (X linked) cytoplasm- porphyria's both- lead poisoning

Question 79

vasculitis associated with Hep B and inflammation type?

Answer 79

polyarteritis nodosa. Transmural necrotizing inflammation

Question 80

urine build up in porphyrias?

Answer 80

acute intermittent porphyria- protoporphyria | porphyria cUtanea tarda- Uroporphyria

Question 81

MACROlides (azithromycin, erythromycin, ect.) adverse effects

Answer 81

``` Motility issues Arrhythmia (QT prolongation) Cholecystic hepatitis Rash eOsinophilia ``` also inhibit p450 enzymes

Question 82

mumps complications

Answer 82

parotitis, pancreatitis, orchitis, meningitis, sub acute pan-sclerosing encephalitis

Question 83

meniscus tears and rotation

Answer 83

medial- click on external rotation | lateral- click on internal rotation

Question 84

lateral knee trauma's unhappy triad

Answer 84

MCL, ACL, and medial meniscus tear.

Question 85

Pathology of H-Pylori infection?

Answer 85

solitary lesions with underlying tissue replaced with chronic inflammatory cells

Question 86

Ménétrier disease path?

Answer 86

Hyperplasia of surface mucosal cells with enlarged rugae . Atrophy of parietal cells and hypertrophy of mucosal cells

Question 87

How do eosinophils attack parasites

Answer 87

antibody-dependent cell-mediated parasite covered in IL-5 on eosinophils then attack. They also slowly induce a chornic type 1 hypersensitivity against the creature.

Question 88

Courvoisier sign

Answer 88

painless jaundice, weight loss = pancreatic adenocarcinoma. most common risk factor is smoking

Question 89

decreasing risk of hemorrhagic cystitis with Cyclophosphamide

Answer 89

mesna- binds toxic metabolites in urine

Question 90

amifostine

Answer 90

prevents cisplatin induced nephrotoxicity

Question 91

VACTERL

Answer 91

Vertebral, anal, cardiac, TE, Renal, Limb abnormalities

Question 92

High drug metabolism what zone of liver

Answer 92

zone 3 furthest from triad

Question 93

anesthetic that can cause seizures

Answer 93

enflurane

Question 94

pain, stiff joints, hyperpigmentation of sclera or skin

Answer 94

homogentisic acid oxidase def resulting in an accumulation of homogentisic acid. Limit dietary tyrosine and L-phenylalanine

Question 95

AAA repair common complication

Answer 95

Inferior mesenteric artery ischemia

Question 96

Diuretics that can cause gout

Answer 96

Thiazides

Question 97

Molar pregnancy gentics

Answer 97

full Mole. No fetal parts 46XX | Partial. fetal parts 69XXX

Question 98

how does DCIS to IDC what mutation

Answer 98

metalloproteases to degrade basement membrane

Question 99

Saliva ion concentrations and flow rate

Answer 99

Lower K, Higher Na Cl, and HCO3 secretion with higher flow rate

Question 100

Infliximab vs Etanercept mech difference

Answer 100

Infliximab- binds soluble TNF-a | Etanercept- competitive inhibitor at TNF-a receptor

Question 101

Symptomatic Pheochromocytoma two drugs for MM before surgery

Answer 101

Phenoxybenzamine- long acting for most symptoms Irreversible inhibitor Phentolamine- SA, short word for acute hypertensive crisis. reversible inhibitor both nonselective alpha blockers

Question 102

achondroplasia

Answer 102

most common congenital dwarfism. mut in fibroblast growth factor3 gene. assoc with advanced paternal age.

Question 103

CREST syndrome

Answer 103

calcinosis, Raynaud's, esophageal dysmotility due to atrophy, sclerodactyly, telangiectasias

Question 104

Rosacea vs pityriasis rosacea

Answer 104

Rosacea- face, sun bad, telangiectasias possible | pityriasis rosacea- back, herald patch, Christmas tree,

Question 105

Maple Syrup Urine Disease

Answer 105

lethargy, seizures, early in life. Deficiency of branched chain α-keto acid dehydrogenase. Limit "I love Vermont" I,L,V amino acids and give thiamine (B1) bc it is required by enzyme

Question 106

zidovudine class and side effect

Answer 106

NRTI, anemia

Question 107

HIV NRTI associated with hypersensitivity rxn

Answer 107

abacavir (atopic-avir)

Question 108

Abx that bind 30s ribosome classes

Answer 108

Irreversible binding to 30s- aminoglycosides | reversible binding to 30s- tetracyclines

Question 109

PDE-5 inhibitors mechanism to stop ED

Answer 109

increase cGMP

Question 110

Desquamative interstitial pneumonia

Answer 110

middle age pt, hx of smoking, dry cough, SOB, hypoxia | ground glass opacities, low DCO. pigment laden macrophages

Question 111

post strep glomerular nephritis

Answer 111

2 weeks after strep, hematuria. Low C3 LM: large hypercellular glomeruli IF: granular appearance due to IgG and C3 EM: sub epithelial IC humps

Question 112

Gq mnemonic

Answer 112

HAVe 1 M&M | activate phospholipase C and increase protein kinase C

Question 113

antifungal that can increase skin pigmentation

Answer 113

ketoconazole

Question 114

Gi mnemonic

Answer 114

people who are 2 MAD inhibit themselves | decrease cAMP production

Question 115

SCC precursor lesion

Answer 115

actinic keratosis

Question 116

GLP-1 mechanism

Answer 116

increase insulin via the incretin pathway

Question 117

midline neck mass and embryologic remnant

Answer 117

thyroglossal duct cyst | foramen cecum

Question 118

HNPCC (Hereditary nonpolyposis colorectal cancer or lynch) genetic issue

Answer 118

mismatch repair defect. Occurs during S phase

Question 119

Ataxia telangiectasia genetic issue

Answer 119

Non homologous end joining (drunk strands are ataxic)

Question 120

xeroderma pigmentosa genetic issue

Answer 120

Nucleotide excision repair defect. due to thymidine dimer accumulation

Question 121

BRACA 1 and fanconi anemia genetic issue

Answer 121

homologous end joining (2 boobs are homologous) | homologous bloodlines are down

Question 122

hormone that increases in starvation?

Answer 122

cortisol

Question 123

constipation in a diabetic which nerve affected?

Answer 123

pelvic splanchnic

Question 124

cleidocranial dysplasia

Answer 124

skull, teeth, bone abnormalities. Autosomal dominant affects osteoblast abnormalities

Question 125

HLA inheritance in siblings

Answer 125

25% share all, 50% share some, 25% share nothing

Question 126

Statin mechanism

Answer 126

Inhibit HmG CoA and increase LDL expression drawing cholesterol out of the serum

Question 127

determining monoclonality of an endometrial Ca?

Answer 127

X linked isoenzymes

Question 128

what does liver do in response to glucagon

Answer 128

Beta fatty acid oxidation to create energy for gluconeogenesis

Question 129

most common urea cycle def?

Answer 129

ornithine transcarboxylase. Causes build up of ammonia. Emesis, refusal to feed, lethargy, comma

Question 130

dont get enough protein what happens to nitrogen?

Answer 130

negative nitrogen balance, part of every amino acid.

Question 131

cyclosporine moa?

Answer 131

decreases interleukin 2 signal via calcineurin inhibition

Question 132

hypertrophic osteodystrophy

Answer 132

clubbing, arthritis, new bone formation. Usually due to bronchogenic carcinoma

Question 133

Gardner's syndrome

Answer 133

APC mutation 100% chance of colon Ca. osteomas also common

Question 134

Vit deficiency in carcinoid syndrome?

Answer 134

niacin bc more tryptophan converted to serotonin and not vit B3 (niacin)

Question 135

heartburn med that causes constipation

Answer 135

aluminum hydroxide (aluminum binds phosphate and gets heavy and bound up)

Question 136

rIbavIrIn mech?

Answer 136

antiviral Inhibits IMP dehydrogenase so it can't be converted to GMP

Question 137

Orotic aciduria?

Answer 137

megaloblastic anemia in child that is unresponsive to folate and B12. Treat with uridine, due to UMP synthase deficiency

Question 138

endometrial carcinoma (endometrial type) risk & histology

Answer 138

risk: increased estrogen (especially obesity) histology: glandular invasion of myometrium and disorganized tissue

Question 139

Pancoast tumors cause horner's how? What damages each order neuron?

Answer 139

Horner'S (second order sympathetic neuron) 1st order is in spinal cord - spinal cord damage 3rd order goes back up anterior- carotid dissection

Question 140

cells and signaling molecules GI?

Answer 140

Gastrin- G cells Somatostatin- DIE!!! stops everything D cells CholecystokInIn- I cells Secretin- S cells Gastrin inhibitory peptide- Kalk water is basic. K cells

Question 141

6m baby low glucose, high lactic acid/uricemia, hepatomegaly?

Answer 141

Von Gierek a glycogen storage disease. Loss of G6P which breaks down. glycogen which builds up in liver. Baby starves between feeds. sucrose and fructose makes it worse.

Question 142

Immune thrombocytopenic purpura blood smear findings

Answer 142

increased megakaryocytes

Question 143

topical abx that inhibits peptidoglycan wall synthesis

Answer 143

bacitracin. topical due to extreme nephrotoxicity

Question 144

pharyngeal pouches mnemonic?

Answer 144

Ears, tonsils, bottom to top 1. ears 2. tonsils 3. bottom of parathyroid 3. thymus (3 and 4 are especially related) 4. top of parathyroid

Question 145

pharyngeal arches nerves mnemonic

Answer 145

At golden arches children first chew, then smile, then swallow stylishly - or simply swallow - then speak

Question 146

ganciclovir toxicity and mech

Answer 146

nephrotoxicity and myelosuppression Inhibition of the incorporation of dGTP by viral DNA polymerase

Question 147

thiazolidinediones mechanism and major side effect

Answer 147

acts on peroxisome proliferator-activated receptors (PPARs) and sensitizes cell to insulin. water retention "pioglitazone"

Question 148

what is RA factor?

Answer 148

immunoglobulin M antibody against the Fc portion of immunoglobulin G

Question 149

bifid testes embryologic issue?

Answer 149

malunion of the labioscrotal swellings

Question 150

glactose vs fructose metabolism issues

Answer 150

galactose issues- start with breastfeeding, infantile cataracts fructose- begin with introduction of fruit, juice, honey mild: galactokinase def; essential fructosuria severe: galactosemia (galactose 1-p UDIE transferase); hereditary fructose intolerance (All dielase B)

Question 151

allergic (eosinophilic) granulomatosis and angiitis | symptoms and Dx

Answer 151

sinusitis, asthma, lung infiltrates, eosinophilia, vasculitis, neuropathy. Confirm with ANCA (anti neutrophil antibody)

Question 152

What diuretics can make osteoporosis worse?

Answer 152

loop diuretics bc calcium is lost

Question 153

abx that can cause nephrogenic DM

Answer 153

topical demeclocycline, used primarily for acne

Question 154

Carnitine deficiencies vs medium chain acyl-coA dehydrogenase def

Answer 154

Both have hypoglycemic hypo ketosis carintine def- cardiomyopathy Acetoacetate formation is deficient MCAD def- liver dysfunction and hyperammonemia

Question 155

Pompe Disease?

Answer 155

enlarged muscles and heart. hypotonia, hepatomegaly secondary to HF. acid maltase deficiency. PAS positive glycogen accumulates in the lysosome

Question 156

cori disease

Answer 156

limit dextrans accumulation. possible cardiomegaly. mild hypoglycemia. Due to debranching enzyme def

Question 157

Filgrastim

Answer 157

recombinant GCSF cytokine. Helps with immunosuppression from ALL or cancer treatments

Question 158

spike and dome on EM

Answer 158

membranous glomerulonephritis

Question 159

Henoch-Schönlein purpura on IF

Answer 159

Large deposits of IgA in mesangium

Question 160

lead poisoning mechanism

Answer 160

disrupts the incorporation by ferrochelatase of iron into protoporphyrin IX also disrupts ala (aminolevulnic acid)

Question 161

rhomberg test positive, what structure is affected?

Answer 161

medial lemniscus

Question 162

organic acidemia's treatment mnemonic | Can't convert proponyl CoA to methylmalonyl CoA

Answer 162

Limit VOMIT valine, odd chain FA's, methionine, isoleucine, threonine. Presents at 1-2 weeks

Question 163

CLL complication

Answer 163

warm and cold hemolytic anemias

Question 164

Gynecomastia drugs mnemonic

Answer 164

Some Hormones Create Funny Knockers | spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole

Question 165

Disulfiram like reaction drugs mnemonic

Answer 165

Sorry Pals Cant go Mingle | Sulfonylureas (first generation), Procarbazine, certain Cephalosporins, Griseofulvin, and Metronidazole

Question 166

Placental abruption vs previa symptoms

Answer 166

abruption: painful, with contractions previa: painless bleeding without contractions

Question 167

Cremaster muscle comes from what muscle in development?

Answer 167

internal oblique

Question 168

Juvenile Idiopathic Arthritis symptoms/ path

Answer 168

periodic temperatures associated with rash; enlarged lymph nodes, liver, and spleen; RBC-laden macrophages with low hematocrit.

Question 169

indinavir and side effects

Answer 169

protease inhibitor. thrombocytopenia and kidney stones

Question 170

Raltegravir and side effects

Answer 170

integrase inhibitor can cause high CK and Rhabdo

Question 171

laryngeal cancer greatest risk factor?

Answer 171

smoking

Question 172

PTH main effects

Answer 172

increases calcium decreases phosphate in kidney and causes bone to resorb both by breaking down. Net effect ins more Ca and less Phosphate

Question 173

Primary CNS lymphoma description

Answer 173

single ring-enhancing lesion with an angiocentric pattern of CD20+ cells

Question 174

ALS affects what?

Answer 174

Anterior horn and corticospinal tracts

Question 175

Anitschkow cells

Answer 175

Rheumatic fever

Question 176

Di George embryology

Answer 176

3rd and 4th pharyngeal pouches don't develop normally.

Question 177

potter sequence embryology

Answer 177

failure of uretic bud to form properly

Question 178

Vit E deficiency symp

Answer 178

ataxia and even hemolysis bc the red cell membranes get weak

Question 179

midbrain vessel

Answer 179

PCA

Question 180

Pons Vessel

Answer 180

Basilar- medial | AICA- lateral

Question 181

Medulla Vessel

Answer 181

ASA- medial | Pica- PICA lateral

Question 182

Wecners (granulomatosis with polyangiitis)

Answer 182

``` coughing blood chronic sinusitis cervical facial infection kidney C-anca Caseating granulomas cyclophosphamide and corticosteroids ```

Question 183

churg strauss (eosinophic granulomatosis with polyangiitis)

Answer 183

asthma, sinusitis, eosinophilia cardiac issues and purpura/nodules pauchi immune glomerulonephritis

Question 184

Trisomy 18 (edwards)

Answer 184

clenched fists with overlapping fingers rocker bottom feet low ears micrograthia

Question 185

Trisomy 13 (patau)

Answer 185

``` cleft lip holoproencephaly polydactyle aplasia cutis polycystic kidney disease ```

Question 186

how does kidney reabsorb more HCO3

Answer 186

increased Na/H exchange in proximal tubule

Question 187

where do sperm acquire motility?

Answer 187

spermatogenesis takes place in seminiferous ducts but, motility is acquired in the epididymis, which is lined with a layer of pseudostratified columnar epithelium with stereocilia

Question 188

If you are putting a central line in the jugular where do you go?

Answer 188

within the carotid sheath lateral to the common carotid artery and anterior to the vagus nerve.

Question 189

renal osteodystrophy physiology?

Answer 189

- Kidney sucks so phosphate increases - phosphate blocks calcium in blood - PTH responds to low calcium and bone is broken down

Question 190

dantrolene mech

Answer 190

binds to ryanodine receptors and blocks calcium release from the sarcoplasmic reticulum.

Question 191

RB mutation cancers?

Answer 191

Osteosarcomas, Bladder cancer, Retinoblastomas | ROB the RB gene

Question 192

esmolol role in arrhythmia

Answer 192

See if the pt will tolerate a beta blocker with comorbidities. It only acts for 7mins so pt wont die if they become hemodynamically unstable

Question 193

common finding in obstructive and restrictive pathology?

Answer 193

Decreased vital capacity and inspiratory reserve volume

Question 194

HOT T-Bone stEAK

Answer 194

IL 1- Hot (fever) IL 2- T (Stimulates T cells) IL 3- Bone (bone growth) IL 4- E (class switching to IgE and IgG) IL 5- A (class switching to IgA) eosinophils asthma IL 6- K (aKute phase reactants, megaKaryocytes) also increases plts as part of inflammation

Question 195

Telling ANCA disorders and Goodpasture's apart?

Answer 195

good pastures is usually a young male and will light up glomeruli on immunostaining

Question 196

Hereditary hemochromatosis

Answer 196

AR. Dysregulated hepcin leading to increased iron absorption

Question 197

Langerhans cell histiocytosis?

Answer 197

``` skin macrophages invade various organs Birbeck granules (look like tadpoles) on EM ``` bone tenderness eczematous rash and spontaneously resolving brownish purple papular lesions.

Question 198

How does Staph aureus TSS toxin work?

Answer 198

cross links MHC II

Question 199

Most common genetic hyper coagulability?

Answer 199

Factor 5 Leiden (AD) | preventing protein C from degrading factor V

Question 200

Vascular tumor growth is driven by what?

Answer 200

VEGF and FGF

Question 201

Inability to fight mycobacterial infections and poor rxn to BCG vaccine?

Answer 201

IL-12 receptor deficiency

Question 202

allelic heterogeneity?

Answer 202

different mutations in the same locus resulting in a similar phenotype.

Question 203

jaw mneumonic

Answer 203

Remember "Lateral Lowers" and "M's Munch" Lateral pterygoids Medial pterygoids, Masseter, teMporalis

Question 204

Familial hyperlipidemia with high LDL who fail statin next step?

Answer 204

and ezetimibe or a psk9 inhibitor

Question 205

BCL-2 function?

Answer 205

inhibits apoptosis

Question 206

VWF deficiency

Answer 206

most common cause of increased bleeding | vwf acts as a ligand in plt adhesion

Question 207

Trigeminal nerve exits V1, V2, V3

Answer 207

standing room only | Superior orbital fissure, foramen Rotundum, and foramen Ovale,

Question 208

Norepi sympathetic mechanism

Answer 208

increased AV nodal conduction velocity via increased Ca2+ influx

Question 209

methotrexate mech

Answer 209

inhibits dihydrofolate reductase.

Question 210

drug metabolism and solubility

Answer 210

fat soluble- thoracic duct (no first pass) water soluble- portal vein (first pass) ports assoc with water

Question 211

prostate cancer is found in what zone

Answer 211

peripheral zone

Question 212

what artery supplies Merkle diverticulum

Answer 212

Superior mesenteric artery

Question 213

Leukocyte adhesion deficiency molecular issue

Answer 213

loss of CD18 integrin

Question 214

malignant PKU enzyme def.

Answer 214

dihydrobiopterin reductase

Question 215

Steatorrhea kidney consequences

Answer 215

decreased oxalate/calcium complex exertion so more kidney stones

Question 216

abciximab

Answer 216

Inhibits glycoprotein IIb/IIIa

Question 217

low blood volume and afferent arteriole

Answer 217

High NE and Angiotensin II constricts but is counteracted by vasodilation on prostaglandins Don't give lots of NSAIDS to volume down pts

Question 218

Bleomycin vs Busulfan pulmonary fibrosis?

Answer 218

Bleomycin- months to weeks post trx | Busulfan- years after trx

Question 219

macrolides mechanism?

Answer 219

50S ribosome subunit

Question 220

Aorta rupture from deceleration common location

Answer 220

aortic isthmus (right where it starts to go down after left subclavian)

Question 221

Absolute contraindication with Cocaine MI

Answer 221

B blockers. Would lead to unopposed alpha leading to vascular constriction

Question 222

polyarteritis nodosa hypersensitivity type

Answer 222

Type III

Question 223

Hyper IgM syndrome molecular issue

Answer 223

Defective CD40L on T-helper cells doesn't allow class switching

Question 224

hepatorenal syndrome physiology

Answer 224

dilation of splanchnic vessels. constriction of renal vessels. causes pre-renal azotemia

Question 225

pilocarpine and pupil

Answer 225

constricts pupil and decreases intraocular pressure via M3 agonism

Question 226

ulnar nerve comes from what trunk?

Answer 226

lower

Question 227

what cells produce androgen binding protein?

Answer 227

Sertoli cells

Question 228

Muscular dystrophy inheritance

Answer 228

X-Linked recessive

Question 229

Bleomycin mechanism

Answer 229

induces DNA strand breaks by producing superoxide and hydroxide free radicals that lead to DNA cleavage

Question 230

IgA nephropathy vs PSGN?

Answer 230

both can be in kids IgA- sore throat and hematuria at the same time. Mesangial deposits PSGN- sore throat 3-6wks before hematuria. sub epithelial humps

Question 231

Quinidine adverse effects?

Answer 231

Torsades and cinchonism, a syndrome that includes headaches and tinnitus

Question 232

WPW blood flow issue

Answer 232

decreased filling of the ventricle during diastole due to early ventricular depolarization

Question 233

Splenomegaly, burr cells, transfusion

Answer 233

pyruvate kinase deficiency

Question 234

pancreatitis electrolyte complication

Answer 234

hypocalcemia

Question 235

Trousseau syndrome and cause

Answer 235

pancreatic ca + migrating swelling and pain thrombophlebitis from tissue factor liberating clotting factors.

Question 236

Dubin Johnston

Answer 236

High direct bilirubin | black liver

Question 237

Gram negative coccobacillus. Rapidly expanding infection post dog or cat bite

Answer 237

Pasteurella multocida

Question 238

TB Ghon complex description?

Answer 238

caseating granulomas with multinucleated giant cells and epithelioid cells surrounding an area of central necrosis

Question 239

eczema hypersensitivity type

Answer 239

type 1 Hypersensitivity

Question 240

PHENYTOIN side effects

Answer 240

``` P450 induction Hirsutism Enlarged gums nystagmus Yellow Brown Skin Teratogen Osteopenia Inhibited Folate Neuropathy ``` Rarely SJS, DRESS and drug lupus

Question 241

women hormone replacement therapy effect on thyroid

Answer 241

Increased TBG and total T3/T4 and normal everything else. No symptoms

Question 242

Carbonic anhydrase inhibitor mechanism and changing urine effects

Answer 242

Increases HCO3 and volume losses alkalizing the urine

Question 243

LH in PCOS?

Answer 243

High

Question 244

What error type decreases with increased sample size?

Answer 244

Type II or missing the statistical significance

Question 245

How does Warfrin work

Answer 245

suppresses carboxylation of precursor proteins that utilize vit K

Question 246

Infusion rate formula

Answer 246

Drug clearance x Steady State Drug concentration plasma

Question 247

How does Breast Ca mets get to vertebral column

Answer 247

intercostal veins

Question 248

Glucosamine from F-6-P required cofactor

Answer 248

glutamine

Question 249

eversion ankle sprain muscle that causes pain

Answer 249

Fibularis (peroneus) brevis

Question 250

Jersey finger injury and innervation

Answer 250

flexor digitorum profundus (C8)

Question 251

Autosomal trisomy with increased b-HCG

Answer 251

Trisomy-21

Question 252

Autosomal Trisomy all values down

Answer 252

Trisomy 18. Inhibin may be normal or decreased

Question 253

Nerves that may impair reinnervation peripherally

Answer 253

Schwann cells

Question 254

What do 5-FU and capecitabine inhibit

Answer 254

thymidylate synthetase

Question 255

What binds TATA box

Answer 255

RNA polymerase

Question 256

Feathery appearance on contrast GI x-ray due to what

Answer 256

A lot of mucosal surface area

Question 257

trx for child with severe diarrhea

Answer 257

sodium and glucose IV (or orally if worried in an office setting)

Question 258

Interosseous muscle innervation

Answer 258

ulnar nerve

Question 259

Plantar flexion nerve

Answer 259

tibial nerve

Question 260

most common surgical injury during radical proctectomy

Answer 260

pelvic parasympathetic nerves

Question 261

prostate cancer what type of lesions

Answer 261

osteoblastic lesion

Question 262

nicotinic acid mechanism in cholesterol distribution

Answer 262

takes cholesterol from hepatocytes to VDRL in circulatory system

Question 263

aspirin allergic pts should use what for headaches?

Answer 263

acetaminophen

Question 264

Binding of prednisone?

Answer 264

Binds cytosol receptor with translocation into nucleus

Question 265

Islets cells of pancreas comes from what cell type embryologically

Answer 265

Endoderm

Question 266

In SCID due to adenosine deaminase def what enzyme is inhibited by high dATP levels?

Answer 266

Nucleoside monophosphate kinase

Question 267

What lipid lowering agent increases muscle issues of statins?

Answer 267

Gemfibrozil

Question 268

Respiratory compliance equation

Answer 268

Change in volume/ Change in pressure

Question 269

Dicumarol?

Answer 269

Depletes Vit K just like Warfrin. Prolongs PT

Question 270

Common secondary Ca from hodgkin lymphoma trx?

Answer 270

AML

Question 271

What pharmacology value does not change with pt GFR function?

Answer 271

Loading dose

Question 272

Chronic granulomatous disease susceptibility

Answer 272

Catalase positive organisms | S. Aureus, pseudomonas, serratia, nocardia, aspergillosis and candida

Question 273

seizure with aura lobe of the brain?

Answer 273

Temporal lobe

Question 274

stenting right kidney catheter advanced just beyond what artery

Answer 274

Right testicular is just below the renal access.

Question 275

laxitive abuse electrolyte issue?

Answer 275

hypokalemia

Question 276

First line for someone with recurrent pancreatitis or at high risk and has familial hypertriglyceridemia?

Answer 276

Niacin (works on VLDL) as fibrates are contraindicated

Question 277

Major component of surfactant?

Answer 277

dipalmitoyl lecithin

Question 278

diarrhea drug that has opiod properties at high doses

Answer 278

loperamide.

Question 279

Foam cells in child?

Answer 279

Niemann-Pick composed of sphingomyelinase

Question 280

Rheumatoid arthritis HLA assoc?

Answer 280

HLA DR4. 4 walled Rheum (room)

Question 281

Thyroid hormone secreting ovarian tumor?

Answer 281

struma overii

Question 282

tropic spastic paraparesis cause?

Answer 282

HTLV-1

Question 283

amantadine

Answer 283

used to treat influenza, now used for parkinson thought to increase Dopamine release and inhibit degradation

Question 284

Renal Cell Carcinoma

Answer 284

palpable mass, often spreads to lungs trx is recombinant IL-2 called aldesleukin

Question 285

Osteopetrosis which cell has the issue?

Answer 285

dysfunctional osteoclasts. However normal osteoblast then make bone too thick after.

Question 286

What is influenced by the disease prevalence in a population?

Answer 286

Positive predictive value

Question 287

Chronic rejection (over 6m) of liver transplant what is damaged

Answer 287

small airways Bronchiolitis obliterans

Question 288

lung changes with normal aging?

Answer 288

less compliance decreasing the FEV1 and increasing residual volume

Question 289

Anesthesia that causes bronchodilation and is preferred in asthma?

Answer 289

halothane and sevoflurane

Question 290

fluorinated anesthetics and the brain side effect?

Answer 290

Increase ICP and cerebral blood flow

Question 291

Harnup disease

Answer 291

rash, ataxia and neutral amino acids in urine trx with niacin.

Question 292

Most important immune component of lung abcess formation

Answer 292

Neutrophils releasing lysosomal contents

Question 293

Subdural hematoma

Answer 293

crescent (crescent roll sub) bridging veins (slow decline bc venous)

Question 294

Antiviral mechanism of interferon a and b?

Answer 294

Decreases protein synthesis in any cell with double stranded RNA due to viral infection

Question 295

ragged red fibers on muscle biopsy, what type of diseses?

Answer 295

mitochondrial inheritance

Question 296

amyl nitrate

Answer 296

cyanite tox antidote. coverts heme to methemoglobin which then binds cyanide keeping it in the blood so it cant poison mitochondria

Question 297

locus ceruleus location and function

Answer 297

posterior rostral pons under floor of 4th ventricle. Secretes Norepinephrine for arousal

Question 298

last cell type to disappear from bronchioles down to alveoli?

Answer 298

ciliated cells

Question 299

toxo physical description?

Answer 299

intracellular and crescent shaped

Question 300

how does insulin activate glycolysis?

Answer 300

activates PFK2 which produces fructose 1,6 bisphosphate

Question 301

Anticholinergic toxicity (ex; jimson weed)

Answer 301

Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, full as a flask, fast as a fiddle. Physostigmine

Question 302

GI atresia embryologic issue

Answer 302

Duodenum- recanalization issue 8-10wks double bubble x-ray | Jejunum/ilium- vascular injury

Question 303

Macrophage cell surface marker

Answer 303

CD14

Question 304

Kozac consensus sequence?

Answer 304

Bunch of gcc's before AUG that help initiate translation

Question 305

sickle cell biochem?

Answer 305

mutated protein hydrophobic pocket allows for sickling

Question 306

on release from SR calcium binds what in the muscle

Answer 306

Troponin C

Question 307

Heparin overdose bleed trx

Answer 307

protamine sulfate

Question 308

Nerve block for anything in medial leg

Answer 308

femoral block. Inject under inguinal ligament

Question 309

achlasia electrophysiology

Answer 309

upper normal, esophagus low amplitude and Lower spincter is hyperexcited and does not relax

Question 310

celcoxib?

Answer 310

(Selective cob b- or 2- inhibitor just what is sounds like

Question 311

S 100 positive cancers?

Answer 311

neural crest derived cancers schwannoma and melanoma

Question 312

Carpal tunnel ligament what structure traps median nerve?

Answer 312

Transverse carpal ligament (flexor riticulatum)

Question 313

IL-10

Answer 313

released by macrophages. Anti inflammatory. Important in healing

Question 314

primary hyperparathyroidism?

Answer 314

Common cause of isolated elevated Ca. Due to cortical reabsorption and sub periosteal erosions.

Question 315

Class 1 antiarrhythmic mneumonic

Answer 315

A Queen's Panini Doesn't Beat Lidie's Mexican Carne Fajitas Platter.

Question 316

Deep brain simulation for Parkinson's what area?

Answer 316

Gp internus or usually the subthalamic nucleus

Question 317

knee flexion nerve

Answer 317

sciatic L4-S3

Question 318

DMII drugs that increase insulin secretion via closing a K+ channel in B Cells of pancreas

Answer 318

Sulfonureas 1st gen- "amides" disulfiram rxns Sulfonureas 2nd gen- "glipizide & glypuride" Meglitinides- "glins"

Question 319

Before alanine is converted to glucose in the liver who takes the amino group?

Answer 319

Alphaketoglutarate which requires Vit B6 (thiamine)

Question 320

accuracy of a screening test?

Answer 320

area under the curve

Question 321

PCOS infertility trx if clomiphene fails?

Answer 321

Drugs that mimic FSH of LH surge near ovulation

Question 322

post MI scarring involves what type of collagen?

Answer 322

Type 1

Question 323

Central DI how do you know where it happened

Answer 323

Permanent: Hypothalamus transient: posterior pituitary

Question 324

Fenoldopam

Answer 324

D1 agonist with multiple positive effects in hypertensive emergency especially if there is kidney damage.

Question 325

Sirolimus?

Answer 325

anti IL-2

Question 326

ENaC inhibitors?

Answer 326

Amiloride and triamerene

Question 327

Who is predisposed to Drug induced lupus

Answer 327

People who's livers are slow acetylators

Question 328

Halothane?

Answer 328

Inhaled anesthetic with MAJOR acute hepatocellular Liver injury causing the organ to shrink and increases LFTs and PTT

Question 329

Oral HPV locations?

Answer 329

young pt. base of tongue or tonsils, keratized pearls.

Question 330

methadone adverse effect?

Answer 330

QT prolongation

Question 331

CAH 21 hydroxylase def treatment?

Answer 331

ACTH low doses therapy to provide negative feedback

Question 332

Ankylosing spondylitis inflammatory molecules

Answer 332

IL-17 and TNF-Alpha

Question 333

how does thiamine deficiency cause damage

Answer 333

low erythrocyte transketolase activity

Question 334

Ectopic pregnancy description on histology?

Answer 334

Decidualized endometrium- dilated, coiled endometrial glands and vascular stroma

Question 335

Diabetic cataracts biochemistry

Answer 335

glucose is converted to fructose but sorbitol and intermediate accumulates.

Question 336

Ethosuximide (anti-epileptic) mechanism

Answer 336

Blocks thalamic T-type Ca channels

Question 337

Major Biochemical rxns of the mitochondria?

Answer 337

TCA cycle, Beta-oxidation of FA's, gluconeogenesis (carboxylation of pyruvate)

Question 338

Major Biochemical rxns of the cytosol?

Answer 338

Glycolysis, Synthesis of FA's, pentose phosphate pathway

Question 339

Why is Amphotericin B so terrible (amphoterrible) ?

Answer 339

Renal damage that causes Low Mg and K via epithelial damage?

Question 340

REID index?

Answer 340

comparison of mucus glands to area of between epithelium and basement membrane. High ratio indicates more severe chronic bronchitis/COPD

Question 341

Enzyme produced by mast cells in response to anaphylaxis by mast cells

Answer 341

typtase

Question 342

protoporphyria's and symptoms relative to pathway

Answer 342

Early enzyme deficiencies- neuropsychiatric symptoms PBG def | Late enzyme deficiencies- sun sensitivities Uroporphyrinogen def

Question 343

tissues that increase Glut 4 in response to insulin

Answer 343

Muscle cells and adipose

Question 344

Rifaximin and Lactulose moa?

Answer 344

Rifaximin decreases gut flora's ability to produce ammonia bc it is an abx Lactulose lowers pH after conversion to short chain FA and increases conversion to ammonium in the gut

Question 345

Mifepristone and misoprostol moa's?

Answer 345

Mifepristone- progesterone's stop (antagonism) | misoprostol- prostaglandin E1 agonist

Question 346

enfuvirtide

Answer 346

stops gp41 conformational change inhibiting fusion of HIV virus to host cells

Question 347

HIV integrase inhibitors drug name ending

Answer 347

"tegravir" all can cause elevated ck

Question 348

what type of muscle does not rely of extracellular calcium to work?

Answer 348

skeletal muscle uses RyR channel to get Ca from SR instead

Question 349

Lac operon 2 methods of regulation

Answer 349

1. Positively- cAMP-CAP upstream of promoter | 2. Negatively- repressor protein binding to operator locus

Question 350

germinal centers of lympnode follicles B cell actions

Answer 350

Isotype switching and proliferation response to invader

Question 351

what is in the lower leg anterior compartment?

Answer 351

Tibial artery/vein, deep peroneal nerve, foot extensor muscles

Question 352

what immune cells cause inflammation in gout?

Answer 352

neutrophils

Question 353

Metyraphone stimulation test physiology?

Answer 353

Negative feedback to HPA axis to decrease cortisol synthesis. Leads to reactive ACTH surge and build up of intermediates 11-deoxycortisol and 17-hydroxysteroid levels.

Question 354

fixed dilated pupils

Answer 354

midbrain lesion

Question 355

RNA interference?

Answer 355

Short double stranded RNA molecules block translation in ribosome

Question 356

BPHP that responds to finasteride that has what cellular predominance?

Answer 356

Epithelial predominance. Non-responders usually have a smooth muscle and collagen predominant hyperplasia

Question 357

How does gigantism result in big hands/feet/jaw

Answer 357

Excess GH stimulates liver to produce insulin like GF 1 which directly stimulates bone, soft tissue, cartilage

Question 358

Bacterial and chemo agent resistance mut?

Answer 358

Multidrug resistance gene mutations result in a ATP dependent transporter that just pumps drugs out of the cell

Question 359

Treatment of absence seizure + tonic clonic activity?

Answer 359

Valproic acid

Question 360

Di George Embryologic issue

Answer 360

failure of III and IV pharyngeal pouch development

Question 361

Stop codons

Answer 361

UAA, UGA, UAG

Question 362

Linkage disequilibrium and calculation

Answer 362

Genes are inherited together more or less than expected. Just multiply frequency allele 1 x frequency allele 2

Question 363

Postpartum thyroiditis cell type

Answer 363

Lymphocytic invasion with diffusely decreased R-iodine uptake. Similar to Hashimoto's but occurs within 1 year of P and resolves

Question 364

Initial drug for status epilepticus

Answer 364

IV Bezo's

Question 365

Cdiff treatment that inhibits RNA polymerase

Answer 365

Fidaxomicin (has less effect on good bacteria than vancomycin)

Question 366

midline neck mass that moves

Answer 366

thyroglossal duct cyst

Question 367

most common protein altered in familial dilated cardiomyopathy?

Answer 367

titin. Often Autosomal dominant with variable penetration

Question 368

essential fructoseuria enzyme def and why is it so mild?

Answer 368

defect in fructokinase but hexokinase can still covert the fructose

Question 369

what happens to pyruvate during hypoxic conditions?

Answer 369

NADH accumulation inhibits pyruvate dehydrogenase so production is shunted to lactate instead

Question 370

testicular hydrocele what is the issue

Answer 370

tunica vaginalis

Question 371

chronic diarrhea or illeostomy and stones?

Answer 371

pure uric acid stones due to low urine pH

Question 372

when does expiratory stridor occur?

Answer 372

tracheomalacia

Question 373

treatment for pressor leak that threatens to vasoconstrict a limb to death?

Answer 373

Phentolamine locally to antagonize a1 stimulation

Question 374

nondisjunction in trisomy 21?

Answer 374

maternal nondisjunction during meiosis 1

Question 375

Osteoclasts in paget's disease of bone

Answer 375

numerous & large up to 100+ nuclei. Excess differentiation driven by M-CSF and Rank-L (aka nuclear factor kappa beta)

Question 376

shortening of 4th toe and ephysial dysplasia

Answer 376

Refsum disease. Peroxisome issue phytanic acid build up

Question 377

what happens if the midgut fails to rotate around the SMA?

Answer 377

fibrous band obstruction of duodenum and/or volvulus

Question 378

murmur best heard with the pt sitting up and leaning forwards?

Answer 378

aortic regurgitation

Question 379

excess raw egg white consumption decreases what vitamin?

Answer 379

B7 (Biotin)

Question 380

Biochemical rxn that utilize vit B7?

Answer 380

Carboxylase enzymes 1. Pyruvate to oxaloacetate (gluconeogenesis) pyruvate carboxylase 2. Acetyl CoA to Malonyl CoA (FA synthesis) Acetyl CoA carboxylase 3. Propionyl CoA to methylmalonyl CoA (FA oxidation) Propionyl CoA carboxylase

Question 381

What meds should be avoided in HCM?

Answer 381

anything that drops preload is bad. Vasodialators and diuretics

Question 382

Gerstman syndrome lesion location

Answer 382

angular gyrus of dominant parietal lobe

Question 383

Embryonic origins of craniopharyngioma

Answer 383

Rathke's pouch which forms anterior pituitary

Question 384

skateboarding associations of distribution skew

Answer 384

Positive skew: Camel hump Negative skew: ramp named after the tail of data which pulls mean out

Question 385

MEN mutations

Answer 385

Men 1: Menin (MEN1) 3P's Men 2A: Tyrosine kinase (RET) 2P's & 1M Men 2B: Tyrosine kinase (RET) 2M's & 1P

Question 386

Chronic glucocorticoids and liver enzymes

Answer 386

increased gluconeogenesis enzymes

Question 387

Antibodies in thyroid diseases

Answer 387

TPO: Hashimoto's, postpartum thyroiditis | TSH receptor: Graves

Question 388

Nerve most commonly injured during thyroidectomy

Answer 388

external (recurrent) laryngeal nerve innervating the cricothyroid

Question 389

Temporal lobe epilepsy path findings?

Answer 389

Temporal Astrocytic proliferation in response to hippocampal sclerosis/atrophy

Question 390

Ulcer in the distal duodenum?

Answer 390

Zollinger Ellison syndrome

Question 391

Secretin test and ZES?

Answer 391

paradoxical increase in gastrin due to abnormal adenyl cyclase activity

Question 392

What is need to calculate CO from a Swan Ganz catheter?

Answer 392

rate of 02 consumption/ arteriovenus 02 content difference

Question 393

Important gene in granulation tissue and vascularization?

Answer 393

VEGF can overproduce granulation tissue in secondary intent healing delaying recovery

Question 394

gap junctions made of what protein?

Answer 394

connexins (connect/communication)

Question 395

hemidesmosomes are made of what cell type?

Answer 395

integrins

Question 396

Oxybutynin mechanism?

Answer 396

antagonizes M3 receptors to decrease detrusor contraction exact opposite of bethanechol

Question 397

retroperitoneal hematoma can cause what neuropathy

Answer 397

femoral nerve (patella reflex and anterior thigh)

Question 398

Nitric oxide is synthesized from what AA

Answer 398

arginine

Question 399

PPI inhibitors and nutrient absorption

Answer 399

Increases: fat absorption Decreases: calcium, iron, Mg, B12

Question 400

Octreotide mech and indications?

Answer 400

somatostatin analog. acromegaly, carcinoid syndrome, variceal bleeding

Question 401

Molecular motor proteins mneumonic?

Answer 401

REaDY AttacK Retrograde- dynein Anterograde- Kinesin

Question 402

Interscalene block risk

Answer 402

also paralyzes unilateral diagram so avoid in pts with underlying lug dz

Question 403

What major reactions is NADH used for?

Answer 403

cholesterol/FA synthesis and as a gluthione anti oxidant mechanism

Question 404

Dark bit inside the nucleus what is it?

Answer 404

Nucleolus this is where RNA polymerase 1 transcribes ribosomal gene

Question 405

Pulmonary Arteriole Hypertension signaling disfunction

Answer 405

Too many constrictors: Thromboxane and endothelin | Not enough dilators: NO and Prostacyclin

Question 406

Heart failure cells in lung parenchyma?

Answer 406

hemosiderin laden macrophages described as "golden brown granules that turn blue with prussian stain"

Question 407

Aortic notch artery branches right to left?

Answer 407

brachiocephalic, left common carotid, Left subclavian

Question 408

most common part of the nephron obstructed by uric acid stones?

Answer 408

Collecting duct due to low pH causing precipitation

Question 409

Epidermolysis bullosa and mutated protein

Answer 409

minor trauma = bullae. Keratin mutated

Question 410

Angelman vs Williams syndrome

Answer 410

Angelman: inappropriate laughter chromosome 15 paternal silencing and maternal bit lost Williams: Will Pharrell in elf. Friendly, elfin appearance chromosome 7

Question 411

PSaMoMa bodies mneumonic

Answer 411

Papillary carcinoma of the thyroid Serous cystadenocarcinoma of the ovary Meningioma Mesothelioma

Question 412

B1 (thiamin) chemical reactions

Answer 412

Be APT (all dehydrogenase rxns) 1. Branched-chain ketoacid dehydrogenase 2. a-ketoglutarate dehydrogenase (TCA cycle) 3. Pyruvate dehydrogenase (glycolysis and TCA cycle) 4. Transketolase (HMP shunt)

Question 413

Location of the parietal cells and chief cells in gastric mucosa

Answer 413

Top simple columnar cells upper glandular layer- parietal cells Lower glandular layer- chief and delta cells

Question 414

Hennoch schonlein purpura other name

Answer 414

Ig A vasculitis

Question 415

why does one get hypogonadism in hemochromatosis?

Answer 415

iron deposition in the pituitary gland

Question 416

Staph aureus that causes tissue necrosis?

Answer 416

MRSA that gains leucocidin via a bacterial phage

Question 417

when are monoclonals (cetuximab, panitumumab) against EGFR ineffective?

Answer 417

mutated KRAS

Question 418

clasp knife spasticity location

Answer 418

internal capsule

Question 419

what anesthetic are myasthenia gravis pts susceptible too?

Answer 419

vecuronium, but are resistant to succinylcholine

Question 420

What is homocysteine normally converted too?

Answer 420

methionine (homo that does meth)

Question 421

how does physiologic pleural fluid get there?

Answer 421

in from micro intercostal vessels out through parietal pleural lymphatics

Question 422

in a pacemaker where is the LV pacing lead placed?

Answer 422

coronary sinus in the atrioventricular groove

Question 423

Pip-Tazo antibiotic class

Answer 423

penicillin and a beta lactamase inhibitor

Question 424

TRX for nephrogenic DI

Answer 424

Thiazide diuretics so more sodium and H2O is absorbed proximally

Question 425

How many half lives to reach a steady state concentration?

Answer 425

4-5

Question 426

cyclophosphamide mech and cell cycle area?

Answer 426

alkylates guanine. Cell cycle non-specific

Question 427

didanosine mech and adverse effects

Answer 427

NRTI used in HIV. Hepatitis and pancreatitis

Question 428

Protease inhibitor ending

Answer 428

"navir"

Question 429

why is imipenem given with cilastatin?

Answer 429

cilastatin prevents its degradation by dhp-1 in the proximal tubule

Question 430

single loud S2 in cyanotic baby?

Answer 430

transposition of the great vessles

Question 431

Esophageal webs and iron def. anemia?

Answer 431

Plummer Vinson syndrome. Can be detected in middle age.

Question 432

Common pathologic cause of bloody nipple discharge

Answer 432

papillary carcinoma described as epithelial cells lining fibrous core

Question 433

p450 inducers mneumonic

Answer 433

Rif some Carbs, Barbs, and Herb and have a Phen Time!

Question 434

p450 inhibitors mneumonic

Answer 434

Certain Silly Compounds Very Annoyingly Inhibit Enzymes, GRRR Cipro, sulphonamide, cimitedine/omeprazole, valproate, antifungals/amiodarone, Isoniazid, Erythromycin, grapefruit juice

Question 435

inhibin in males

Answer 435

produced by sertoli cells inhibits just FSH

Question 436

Jaw jerk reflex what nerve

Answer 436

Trigeminal nerve in and out

Question 437

Chromaffin cells appearance and what stimulates them

Answer 437

adrenal medulla is Blue on H&E | stimulated to produce catecholamines by acetylcholine

Question 438

tap protein?

Answer 438

transports bacterial polypeptide fragments to b2-microglobulin and MHC1 in the ER for cell surface expression of pathogen

Question 439

Disease causing pallor of catecholaminergic brain regions

Answer 439

PKU does this

Question 440

Eosinophilic granulomatous polyangiitis

Answer 440

peripheral neuropathies, late onset asthma, eosinophilia, p-anca

Question 441

CAH sheet rules

Answer 441

``` first #- mineral corticoid/BP Second #- sex hormones K is always opposite bp Cortisol always low, MSH always up 1 = up not 1= down ```

Question 442

how do inflammatory molecules increase insulin resistance?

Answer 442

upregulate serine/threonine kinases

Question 443

What's a way to get Wallenburg syndrome following trauma?

Answer 443

vertebral artery dissection

Question 444

pharmacologic permissiveness

Answer 444

when a hormone exerts no effect by itself but allows other hormones to exert their maximal effect

Question 445

what drug class can mask the symptoms of hypoglycemia?

Answer 445

non-selective Beta Blockers

Question 446

how can niacin be synthesized endogenously?

Answer 446

from tryptophan

Question 447

uniform enlargement of uterus, heavy periods

Answer 447

adenomyosis. Endometrial glands and stroma in endometrium

Question 448

common triggers for COPD exacerbations?

Answer 448

infections or air pollutions

Question 449

celiac disease cancer association?

Answer 449

T-cell cancer

Question 450

what happens to c peptide after insulin synthesis

Answer 450

secreted together in vesicles after being cut in the golgi.

Question 451

calories and common molecules

Answer 451

1 gram carbs and protein- 4kcal 1 gram ethanol- 7kcal 1 gram fat-9kcal

Question 452

TEE probe lies closest to what chamber and what is posterior

Answer 452

``` left atrium (anterior) descending aorta (posterior) ```

Question 453

primary moa of 2'ed gen antipsychotics?

Answer 453

D2 and S2 receptor antagonism 1st gen only do D2 but more potent

Question 454

HIV associated dementia description on path

Answer 454

microglia that form multinucleated giant cells | occurs bc HIV infects microglia which are immune like cells

Question 455

Medullary Thyroid cancer path description

Answer 455

polygonal cells with congo-red positive deposits. calcitonin is a type of amyloid

Question 456

In untreated MG what happens to acetylcholine receptors over time?

Answer 456

endocytosed and degraded due to lack of stimulation

Question 457

common injury site of the common fibular (peroneal) nerve?

Answer 457

``` neck of fibula on knee injury remember PED (peroneal everts and dorsiflexes) ```

Question 458

monotherapy for men with BPH and HTN?

Answer 458

non selective a1 blockers "azosin" such as prazosin. Tamsulosin is uroselective so does not address HTN

Question 459

Why do P women get constipated?

Answer 459

progesterone decreases colon smooth muscle activity

Question 460

TMJ nerve?

Answer 460

Mandibular (V3) branch of trigeminal nerve

Question 461

why doe RBC's have a lot of chloride in the venous blood

Answer 461

it is exchanged in order to get rid of HCO3 produced by carbonic anhydrase

Question 462

doxycycline mechanism?

Answer 462

inhibits protein synthesis by inhibiting 30s ribosome subunit

Question 463

burning pain medial thigh/ anterior scrotum nerve?

Answer 463

ilioinguinal nerve

Question 464

orbital floor fracture possible nerve damaged and symptoms

Answer 464

``` numbness in upper lip, cheek and gingiva infraorbital nerve (part of maxillary nerve) ```

Question 465

HIV diarrhea associations

Answer 465

ulcers/owl eyes- CMV nonulcerative inflammation- cryptosporidium distortion of villi/ no inflammation- microsporidium MAC- necrotizing and non-necrotizing granulomas

Question 466

embryology of hypospadias

Answer 466

lack of urethral fold fusion

Question 467

epithelial ovarian cancer tumor marker

Answer 467

Ca-125. Most common class of ovaria ca. can be serous or mucinous

Question 468

osteogenesis imperfecta physiology

Answer 468

Osteoblast don't make osteoid which in crucial in type 1 collagen.

Question 469

naltrexone for ETOH withdraw mech?

Answer 469

block mu receptors useful to reward pathway

Question 470

what cells produce aqueous humor?

Answer 470

epithelial cells of ciliary body

Question 471

Umbilical cord vessles

Answer 471

1 vein: Oxygenated blood from mom | 2 arteries: deoxygenated blood from fetus

Question 472

pylocytic astrocytoma

Answer 472

children. well circumscribed with a cyst

Question 473

pulsus paradoxus physiology during inspiration

Answer 473

drop in BP, bc with set cardiac volume due to tamponade | RV fills and septum moves toward LV so it cant fill as much and SV decreases

Question 474

alkaptonuria

Answer 474

arthritis + urine turns dark deficiency of homogentisic acid oxidase, an enzyme in the tyrosine degradation pathway, that converts homogentisic acid to maleylacetoacetic acid.

Question 475

Bilirubin conversion disorders

Answer 475

unconjugated: Crigler-Najjar (severe) gilberts (mild) | Conjugated/direct: Dubin Johnson (black liver/severe) and rotor (mild)

Question 476

lacrimal glands M subtype

Answer 476

m3 uses Gq.

Question 477

Hodgkin lymphoma treatment

Answer 477

1st line: ABVD | 2nd Line: MOPP

Question 478

DIC with leukemia?

Answer 478

PML likely M3 auer rod subtype T:15,17

Question 479

Uvula deviation Cranial nerve

Answer 479

Vagus (X) contralateral to deviation direction

Question 480

late catecholamine synthesis defects

Answer 480

dopamine β-hydroxylase deficiency: hypotension hypotonia (uses vit C) catechol-O-methyltransferase: hypertension

Question 481

indinavir side effects

Answer 481

crystal induced nephropathy, thrombocytopenia

Question 482

Folate Vit B9 def biochemical issue

Answer 482

important in 1 carbon transfers and DNA/RNA synthesis

Question 483

High AFP and acetylcholine esterase in amniotic fluid?

Answer 483

failure of neural tube to form bc neural plates do not come together

Question 484

muscle that is under voluntary control that allows for defecation when relaxed?

Answer 484

puborectalis

Question 485

where do bacteria from an aspiration abscess come from?

Answer 485

oral flora

Question 486

Most common component of acute transplant rejection?

Answer 486

Type IV hypersensitivity. CD8 T-cells against recipient against graft MHC molecules

Question 487

Voltage gated Na deadly poisons

Answer 487

Close- Pufferfish/ red tide blooms | open (persistent depolarization)- poison dart frogs (batrachotoxin)

Question 488

Marfan's biochemical issue?

Answer 488

Fibrillin-1 mutation. This normally forms a sheath around elastin

Question 489

murmur in coarctation of the aorta?

Answer 489

flow through collateral blood vessels

Question 490

receptors that decrease insulin secretion

Answer 490

Alpha 2 and somatostatin 2 (SomA(TWO)statIN)

Question 491

Where do H-pylori reside?

Answer 491

gastric antrum

Question 492

angiotensin II and GFR?

Answer 492

constricts efferent tubule increasing GFR

Question 493

what happens after recovery from renal tubular necrosis?

Answer 493

Massive K drop. can be life threatening

Question 494

Hypertrophic osteodystrophy

Answer 494

adenocarcinoma (usually of lung) causes AV shunting and megakaryocytes get into systemic circulation where they release PDGF and VGF in the distal bones causing new bone formation and digit pain

Question 495

sensation of back of posterior tongue and mouth/tonsils and afferent branch of gag reflex?

Answer 495

Glossopharyngeal IX

Question 496

Why can isoniazid cause a sideroblastic anemia?

Answer 496

inhibits pyridoxine phosphokinase which produces PLP a necessary cofactor of ala synthase

Question 497

hypovolemic shock and urea reabsorption?

Answer 497

increased urea reabsorption in order to maximize the concentrating ability of the nephron and resorb more water

Question 498

acute Aortic dissection med

Answer 498

IV esmolol | decreases contractility and heart rate to lessen further damage.

Question 499

What anti arrythmics cause QT prolongation?

Answer 499

1A (Q,P,D) and class III (Amiodarone, ibutilide, dofetilide, sotalol)

Question 500

A-galactosidase A deficiency

Answer 500

Fabry disease neuropathic pain and decreased sweating telangiectasia death from CVA's, cardiac dz, renal failure

Question 501

what in the extracellular matrix does integrin often bind?

Answer 501

fibronectin

Question 502

What enzyme does warfarin inhibit

Answer 502

epoxide reductase. Takes a while for previously made clotting factors to be cleared so bridge with heparin

Question 503

symptoms of a subfalcine herniation

Answer 503

contralateral leg weakness

Question 504

If the pringle maneuver does not stop bleeding where is the blood coming from?

Answer 504

hepatic veins or inferior vena cava

Question 505

cell types female ovaries and hormone production

Answer 505

Theca cells: respond to LH produce progesterone and androgens in the interna Granulosa: respond to FSH convert androgens to estrogen

Question 506

CREST and diffuse scleroderma antibodies

Answer 506

CREST: anti-centromere | diffuse scleroderma: anti topoisomerase 1 (scl-70)

Question 507

most common labs in people with renal stones

Answer 507

normal blood calcium | high urinary calcium exertion

Question 508

why does a normal aortic valve calcify with age?

Answer 508

thought to include fibroblast differentiation to osteoblast like cells

Question 509

Follicular lymphoma symptoms

Answer 509

Long indulgent waxing and waning course painless lymph node involvement t(14:18) blocks cell death nodular pattern on x-ray

Question 510

mixed connective tissue disease

Answer 510

features of lupus + other diseases like scleroderma | antibody against U1 ribonuclear protein

Question 511

metformin mech

Answer 511

inhibits gluconeogenesis | Check Cr before starting

Question 512

mech of fibrates for hypertriglyceridemia?

Answer 512

act on PaRR-a protein to increase transcription of lipases in endothelial cell targets of TAGs. This lowers hepatic VLDL production

Question 513

DNA laddering?

Answer 513

process of apotosis wherein DNA is cut into 180 bp fragments as the cell degrades

Question 514

atropine mech

Answer 514

Ach antagonist

Question 515

germline mutations often affect what cells?

Answer 515

gametes and oocytes

Question 516

calcium dependent intercellular connections?

Answer 516

cadherins form desmosomes and adherens junctions removing extracellular Ca causes dissociation

Question 517

molluscum contagious on path?

Answer 517

caused by poxovirus | molluscum bodies. Eosinophilic inclusions

Question 518

posterior dislocation of the tibia relative to the femur injured structure?

Answer 518

popliteal artery

Question 519

sublimation?

Answer 519

mature defense mechanism. Channeling impulses to socially acceptable behaviors

Question 520

in a healthy pt whith a nephrectomy what is the GFR eventually get too from the healthy kidney?

Answer 520

80%

Question 521

PD5 inhibitors for erectile dysfunction moa?

Answer 521

increase cGMP in corpora cavernousa leading to relaxation

Question 522

High flow in the pancreas due to what?

Answer 522

secretin causes a high HCO3 output and low chloride

Question 523

false positive rate

Answer 523

1 - specificity

Question 524

what do leukotrienes C,D,E promote in asthma?

Answer 524

bronchospasm and vessle permeability

Question 525

nitrates and the heart

Answer 525

decrease preload and cause a reflex tachycardia

Question 526

Albright hereditary osteodystrophy?

Answer 526

GNAS1 mut. short stature and fingers | Causes resistance to PTH so low Ca, high Phosporus and lots of PTH that cant act on receptor

Question 527

what does a N terminal signal sequence addition signify?

Answer 527

bound to the ER so it can be inserted into membrane or secreted. If this is non functional the protein will accumulate in the cytosol

Question 528

Infertility + Normal serum testosterone but low testosterone in the seminiferous tubules

Answer 528

Sertoli cell cell dysfunction causing a lack of androgen binding protein.

Question 529

Pheo vs carcinoid breakdown products

Answer 529

Pheo- palpipations, sweating: Urine metanephrines | carcinoid- diarrhea, flushing, cardiac sclerosis: urine 5-HA

Question 530

Activating tumor mutation that works by transfering signals to the nucleus via the MAPK pathway?

Answer 530

RAS

Question 531

tumor that stains positive for chromogranin and synaptophysin

Answer 531

carcinoid tumor

Question 532

alternate method of protein translation that takes place during apoptosis

Answer 532

translation via "internal ribosome entry sites" where it can begin in the middle of mRNA

Question 533

osteomalacia what cant be formed?

Answer 533

Osteoid bone. Usually due to low Vit D, or calcium

Question 534

what type of abnormal bone is formed in Paget's?

Answer 534

lamellar

Question 535

what muscles does the L. Recurrent laryngeal nerve innervate

Answer 535

L. recurrent laryngeal can be compressed by aortic dilation. Innervates multiple muscles ending in "arytenoid"

Question 536

achalasia imaging and pathophysiology

Answer 536

"birds beak" loss of neurons in Auerbach's plexus

Question 537

examples of unmyelinated or type C fibers

Answer 537

pain, heat and autonomic postganglionic nerves

Question 538

part of MHC II molecule that is digested during antigen processing?

Answer 538

invariant chain

Question 539

what molecules determine cellular differentiation?

Answer 539

transcription factors

Question 540

pernicious anemia

Answer 540

gastric mucosa attacked and parietal cells die. High gastin levels from G cells

Question 541

type of nephrotic syndrome associated with sickle cell, HIV, and heroin addiction?

Answer 541

Focal segmental glomerulosclerosis

Question 542

what section of muscle stretchers and lengthens during relaxation and contraction

Answer 542

I band (non overlapping portion beside z disk)

Question 543

how does prostate ca. met to the spine?

Answer 543

Via prostatic venous plexus

Question 544

Thiazolidinedione's mech and effect

Answer 544

decrease insulin resistance by binding Parr-gamma a nuclear transcription factor

Question 545

Lesch-Nyhan biochem

Answer 545

HGPRT defect so PRPP is able to compensate some with increased activity

Question 546

Type 1 and II error mneumonic

Answer 546

Type I: I=P false positive | Type II: II=N false negative

Question 547

apical wall thinning and dilated esophagus or colon +- dilated cardiomyopathy?

Answer 547

Chagas disease

Question 548

Seronegative spondyloarthropathies HLA serotype?

Answer 548

HLA type 1. assoc with B27 HLA allele

Question 549

erythromycin non-antibacterial indication?

Answer 549

motilin receptor agonist in gastroparesis

Question 550

Metoclopramide mechanism and side effects

Answer 550

D 2 antagonist dystonia and tardive dyskinesia Benadryl can help motor symptoms

Question 551

what types of receptors may have zinc finger nucleases?

Answer 551

intranuclear receptors may act as transcription factors (ex thyroid receptor)

Question 552

where does a bladder rupture to cause intraperitoneal fluid?

Answer 552

bladder dome

Question 553

what portion of the bowel is always involved in Hirschsprung disease

Answer 553

rectum

Question 554

Do diuretics improve mortality in reduced EF HF?

Answer 554

No but ACE, ARB's, NE-ARB's, B-blockers, and mineralocorticoid receptor blockers do

Question 555

new drug +/- fever with urinary eosinophils if urinary WBC's are characterized

Answer 555

interstitial nephritis

Question 556

Fasting and hormones

Answer 556

Glucagon and epi= transmembrane binding | prolonged fasting= cortisol binding intracellularly to alter transcription

Question 557

Decerebrate (extensor) posturing. What is damaged?

Answer 557

Pons and/or midbrain below the red nucleus where the rubrospinal tracks feed

Question 558

why does alveolar capillary blood have slightly higher O2 than systemic arteriolar circulation?

Answer 558

The blood used by bronchi and heart drain venous blood into arteriolar system

Question 559

where does urethral injury from trauma often occur in males (assuming penis is not broken)

Answer 559

right below the prostate by the cowpers gland. Membranous portion of the urethra

Question 560

Down and out eye. what nerve is still okay?

Answer 560

Abducens innervating the lateral rectus | and Trochlear innervating the superior oblique

Question 561

most common early ETOH withdraw symptom

Answer 561

Tremors

Question 562

Penicillin resemble what bacterial cell wall component?

Answer 562

D-ala D-ala

Question 563

Where does phrenic nerve arrive from?

Answer 563

C3-C5 symp: hiccups and shoulder pain with diminished breath sounds on one side

Question 564

Vit A toxicity symptoms

Answer 564

teratogenic, hepatosplenomegaly, Intracranial hypertension, skin changes

Question 565

Pseudo allergic rxn with opiods

Answer 565

Histamine release no IGE component

Question 566

how does radiation therapy damage cancer?

Answer 566

1. Double stranded DNA breaks | 2. Formation of free radicals

Question 567

free fatty acids and DM?

Answer 567

Increase insulin resistance and increase hepatic gluconeogenesis

Question 568

Heart pressures

Answer 568

``` RA: <5 RV: 25/5 PA: 25/10 PCWP: 4-12 LA: <12 LV: 130/10 ```

Question 569

SCC and ear pain?

Answer 569

nasopharyngeal SCC tumor obstructing the eustation tube outlet

Question 570

What do ventral and dorsal portion of pancreas go on to form

Answer 570

Ventral: most of body Dorsal: most of head and main pancreatic duct

Question 571

Infection in pts receiving systemic chemo usually come from where?

Answer 571

endogenous flora penetrating mucosal barriers

Question 572

male genitalia and lymph drainage

Answer 572

interior thigh/penis= superficial inguinal to deep | internal testes= para aortic

Question 573

internal hemorrhoids veins

Answer 573

superior rectal originating for inferior mesenteric

Question 574

what are the two major mechanisms of NAD+ regeneration?

Answer 574

arerobic- TCA cycle | anaerobic- lactate formation

Question 575

How does Ventoclax (BCL2 inhibitor) help in CLL?

Answer 575

makes chemo more likely to induce apoptosis via caspases

Question 576

GBM on stained brain biopsy

Answer 576

central area of necrosis surrounded by pseudo-palisading bodies + vascular proliferations

Question 577

large difference between alveolar and pulmonary venous blood PaO2 but CO2 is normal. Why

Answer 577

indicates diffusion impairment. CO2 is normal bc it is 20x better at diffusing so is not as affected

Question 578

NPH (Wet wacky wobbly) Why these symptoms?

Answer 578

Stretching of descending cortical fibers

Question 579

Ovarian/ testicular Venus drainage

Answer 579

Left into Left Renal | Right goes 'Right' into the IVC

Question 580

The endothelium secretes what in order to oppose Thromboxane A2?

Answer 580

prostacyclin (prostaglandin I2)

Question 581

Ketamine moa?

Answer 581

NMDA antagonist that mimics catecholamine release. Improves bronchospasm. Increased HR and may cause higher ICP

Question 582

What AA is important in renal ammonia genesis?

Answer 582

Glutamine. Helps acidify urine and provide bicarb for buffering the blood

Question 583

Wilms tumor chromosome

Answer 583

Wilhelm is an 11 year old boy who is Wide (Beckwith Wideman)

Question 584

Why does Rigor Mortis happen?

Answer 584

actin and myosin remain bound in the absence of ATP

Question 585

Paget's disease of breast path description

Answer 585

large cells and halo's (Think nipples in the nipple)

Question 586

What organ does polyarteritis classically spare?

Answer 586

lungs

Question 587

VWF disease inheritance?

Answer 587

autosomal dominant

Question 588

Hep B first line trx?

Answer 588

tenofovir disoproxil fumarate (Down to fuck)

Question 589

embryologic origin of the pituitary

Answer 589

anterior: Rathke's pouch, surface ectoderm posterior: neural tube

Question 590

sevelamir mech

Answer 590

binds phosphorus in intestine decreasing absorption

Question 591

Vit E deficiency symptoms similar to what disease

Answer 591

Friedrich ataxia

Question 592

Internal laryngeal nerve mech of injury and symptoms

Answer 592

purely sensory of mucosa above vocal cords. Afferent limb of cough reflex. Injured during food choking injuries and retrieval

Question 593

unilateral swollen red arm and face what VEIN obstructed?

Answer 593

brachiocephalic | Bilateral would be superior vena cava

Question 594

neurosarcoidosis most frequently associated with what tumor type

Answer 594

prolactinoma

Question 595

Loading dose formula

Answer 595

Steady state conc x Volume distribution

Question 596

maintenance dose formula

Answer 596

Steady state conc. x clearance x dose interval

Question 597

BCL2 inhibits what

Answer 597

cell death cascade

Question 598

Berylliosis vs silicosis on biopsy

Answer 598

Berylliosis- noncaseating granulomas | silicosis- birefringent particles, laden macrophages

Question 599

Prokaryotic DNA Polymerase III function?

Answer 599

5 to 3 DNA synthesis. 3 to 5 exonuclease (mismatch repair) activity (prokaryotic DNA polymerase I can do this + remove primers in 5 to 3 exonuclease fashion)

Question 600

Desmopressin moa's

Answer 600

Hemophillia A and vWF def= increases endothelial secretion of VIII and vWF CDI and nocturnal enuresis- Binds V2 receptor and causes increased aquaporin expression and more water absorption

Question 601

Thyroid treatments during P in mothers with Graves dz

Answer 601

Thyroid is developed by 12 in infants but if mother must be treated 1st trimester: PTU (not teratogenic but hepatotoxic) 2nd and 3rd trimester: methimazole which is less hepatotoxic

Question 602

Why is blood venous oxygenation increased in septic shock?

Answer 602

The massive vasodilation and and increased HR causes blood to flow so fast the oxygen cant be properly extracted by the tissue

Question 603

stimulant laxatives?

Answer 603

senna and Bisacodyl

Question 604

VHL disease

Answer 604

AD tumor suppressor gene mutations | Pheochromocytoma, clear cell renal ca, cerebellar and retinal hemangioblastomas

Question 605

physiology of diabetic neuropathy

Answer 605

1. glycosylation leads to hyalinization of endoneurial arterioles 2. sorbitol formation promotes oxidative stress

Question 606

Kidney embryology

Answer 606

pronephros- regresses mesonephros- males deferens and epidymis mesonephros- females vestigial Gardner's ducts Metanephros- Glomeruli to the distal convoluted tubule ureteric bud- collecting system and kidney

Question 607

foscarnet side effects

Answer 607

chelates causing low Ca and Mg resulting in seizures

Question 608

How does hypothyroidism cause high cholesterol?

Answer 608

Decreased LDL receptor gene transcription

Question 609

Insulin special cell signaling

Answer 609

Receptor- Tyrosine kinase Growth and division- RAS/MAPK Glut4 translocation- PIK3 activates > protein phosphatase activates > glycogen synthase

Question 610

midshaft humerus fracture

Answer 610

deep brachial and radial nerve

Question 611

demyelination and electrophysical constants?

Answer 611

Time constant- increases bc takes longer | length constant- decreases bc ap travels less distance before needing a boost from ion channel depolarization

Question 612

pembrolizumab mech?

Answer 612

Antibody against overexpressed Program death ligand 1. Causes CD8 T cell activation to fight cancer

Question 613

gout crystals

Answer 613

needle shaped and negatively birefringent

Question 614

GLP1 agonists

Answer 614

"tide" (tide of modern drugs) weight loss, pancreatitis delayed gastric emptying more glucose dependent insulin, less glucagon

Question 615

Ezetimibe moa

Answer 615

reduces cholesterol absorption at brush boarder via Nieman-pick like transporter protein

Question 616

acute dystonic reactions caused by what

Answer 616

D2 antagonism in nigrostriatal pathway

Question 617

what can be injured during c section when transecting abdominus rectus?

Answer 617

Inferior epigastric artery

Question 618

Best indicator of the severity of a MR and M stenosis murmur?

Answer 618

MR: Presence of an S3 MS: A2 to opening snap time interval. shorter is worse

Question 619

Ehlers Danlos physiology

Answer 619

Type III collagen C and N terminal cleavage issue

Question 620

What is first line for HTN due to cyclosporine or tacrolimus?

Answer 620

Diltiazem

Question 621

Only pathogenic fungus with polysaccharide capsule?

Answer 621

Cryptococcus neoformans. Lets it chill if phagocytosed

Question 622

Barrett's esophagus predisposes to what type of Ca?

Answer 622

adenocarcinoma

Question 623

What muscle can compress the nerve in the sciatic foramen?

Answer 623

Piriformis

Question 624

Motor innervation to muscles of mastication?

Answer 624

Trigeminal nerve V3 exits through foramen ovale

Question 625

Malignancy in 3rd part of duodenum what is compressed?

Answer 625

SMA

Question 626

OCD first line treatment?

Answer 626

SSRI

Question 627

TMJ what muscles can spasm?

Answer 627

masseter and pterygoid

Question 628

Fructose 2,6-Bisphosphate concentrations and rxns

Answer 628

High levels activate activate PFK-1 (glycolysis) and inhibit fructose-1,6 bisphosphatase (gluconeogenesis)

Question 629

What anesthetic carries risk of large K increases?

Answer 629

succinylcholine can also have increased time of duration in pts with pseudocholinesterase mutations

Question 630

Cleft lip and cleft palate

Answer 630

cleft lip: maxillary prominence and intermaxillary segment | Cleft palate: failure of palatine processes fusion

Question 631

maraviroc moa

Answer 631

CCR5 inhibitor to stop macrophage entry

Question 632

Lung cancer endocrine secretions

Answer 632

Small cell: Cushings (ACTH) and SIADH (ADH) | Squamous cell: hypercalcemia (PTHrP)

Question 633

Graves opthalmopathy physiology?

Answer 633

Inflammatory expansion (due to fibroblast activation, causing glucosamine accumulation) of muscle and fat pushing eye out. Treatment is steroids

Question 634

Middle meningeal artery is a branch of which artery?

Answer 634

maxillary artery

Question 635

Cricothyroidotomy goes through what?

Answer 635

superficial cervical fascia and cricothyroid membrane

Question 636

Ovarian torsion always includes rotation of what ligament which tracks with the blood supply

Answer 636

suspensory ligament of the ovary | infundibulopelvic ligament

Question 637

What leads to nephrotic syndrome in minimal change disease

Answer 637

loss of anions in basement membrane allowing albumin into the urine usually due to autoimmune dysregulation

Question 638

Where are VLCFA (very long chain fatty acids) degraded?

Answer 638

peroxisome

Question 639

Sobosfuvir mech

Answer 639

Inhibits RNA dependent RNA polymerase in HepC

Question 640

What structures are in cubital fossa? (front of elbow)

Answer 640

brachial artery and median nerve

Question 641

Functional residual capacity in COPD?

Answer 641

Goes up due to expansion

Question 642

high mitotic index (near 100%) is typical of what

Answer 642

Burkitt lymphoma

Question 643

Why do you get panacinar emphysema in alpha 1 antitrypsin def?

Answer 643

elastases destroy interalveolar septa

Question 644

Annular pancreas embryology

Answer 644

abnormal migration of the ventral bud

Question 645

serum sickness rxns

Answer 645

7-14 days post exposure fever, rash arthralgia low complement and Ig deposition Vessels have fibrinoid necrosis and neutrophil invasion

Question 646

Celiac dz HLA assoc

Answer 646

HLA DQ2 and DQ8

Question 647

What causes obstruction in HOCM?

Answer 647

mitral leaflet and intraventricular septum

Question 648

Benzo mechanism

Answer 648

modulate GABA channel causing more Cl influx in the presence of GABA. Causes more hyperpolarization

Question 649

Medical management of gallstones

Answer 649

ursodeoxycholic acid. basically a hydrophilic bile acid

Question 650

Ghrelin and bariatric surgery

Answer 650

produced by stomach in response to fasting | Many ghrelin secreting cells are lost in procedure leading to less hunger

Question 651

Common tamoxifen side effects

Answer 651

VTE, hot flashes, endometrial hyperplasia and Ca

Question 652

Imiquimod moa

Answer 652

a topical agent that activates Toll like receptor 7 upregulating nf-kb and causes an immune response against abnormal/or proliferating cells in dermatologic conditions. Also increases apoptosis and inhibits angiogenesis

Question 653

phenytoin moa

Answer 653

blocks Na in the motor cortex

Question 654

Neural tube defects what week of development?

Answer 654

4th

Question 655

parotitis serum marker

Answer 655

amylase

Question 656

Ketogenic amino acids that will not be metabolized to pyruvate

Answer 656

Lysine and Leucine. can be protein supplement of ketogenic diet for pyruvate dehydrogenase deficiency

Question 657

Pierre Robinson sequence first embryologic insult?

Answer 657

mandibular prominence misunion leading to micrognathia

Question 658

peptide hormones effect on kidney (ANP and BNP)

Answer 658

dilate afferent, constrict efferent Increase GFR, increase natriuresis and diuresis decrease renin to lower volume status

Question 659

Ortic aciduria vs Ornithine transcarboxylase def

Answer 659

Both have high orotic acid in urine Ortic aciduria- presents at months old can be saved with uridine supplementation. No hyperammonia. megaloblastic anemia Ornithine transcarboxylase def- presents within days or weeks. arginine supplementation helps minimally. no megaloblastic anemia

Question 660

Low BMI what causes low estrogen state?

Answer 660

Low leptin inhibits GnRH pulsatile release and then LH and FSH are low as well

Question 661

parvo virus genetics

Answer 661

nonenveloped single strand DNA virus

Question 662

Multiple myeloma antibodies produced and renal obstruction cause?

Answer 662

mostly IgG. | The Kappa and lambda light chains cause renal obstructions

Question 663

Organophosphate poisoning (farming or serine type gases)

Answer 663

Muscarinic: DUMBELS diarrhea/diaphoresis, urination, miosis, bronchospasm/bradycardia, emesis, lacrimation, salivation nicotinic: fasciculations/ paralysis atropine and pralidoxime

Question 664

Loud pulmonary component of S2

Answer 664

pulmonary HTN a condition assoc with BMPR2

Question 665

where do lower rectal lymph nodes go to?

Answer 665

inguinal region

Question 666

how are monoclonal antibody drugs cleared?

Answer 666

phagocytosis at the target or in the spleen

Question 667

fibrates side effects

Answer 667

gallstones (block bile acid synthesis) | myalgias, not to be combined with statins

Question 668

G6PD deficiency inheritance?

Answer 668

XR

Question 669

Neurotoxic proteins in frontotemporal dementia

Answer 669

TAU (also in Alzheimer's) | abnormally ubiquinated TDP-43 (also in ALS)

Question 670

confidence interval equation

Answer 670

mean ± z score of confidence interval x (sd / (√n),

Question 671

what promotes sickling

Answer 671

low O2, acidosis, dehydration

Question 672

One kidney stenotic what happens in other kidney

Answer 672

decreases renin and excretes more sodium

Question 673

Lack of gag reflex major insight

Answer 673

damaged medulla oblongota (brain death) afferent- glossopharyngeal efferent- vagus

Question 674

cholestyramine

Answer 674

binds bile acids in bowel leading to their excretion. To compensate liver makes more cholesterol

Question 675

what enzymes make fibro atheromatous caps unstable?

Answer 675

metalloproteases secreted by macrophages

Question 676

bicornate uterus embryologic issue

Answer 676

lateral fusion of the paramesonephric duct

Question 677

Other name for hereditary telangiectasia

Answer 677

Osler-Weber-Rendu

Question 678

what is immune privledge?

Answer 678

organs (testes and eye) that are shielded from immune responses

Question 679

young pt back injury with anterior disk displacement

Answer 679

spodylolysis (fracture of pars interarticularis)

Question 680

bacteria produce which vitamins?

Answer 680

K and folic acid

Question 681

Aortic Arches mneumonic

Answer 681

Medical Startup Conference at Science Park 1. Maxillary 2. Stapedial artery 3. Common corticoid/ internal Carotid 4. Aortic arch, rt Subclavian 6. Pulmonary arteries, PDA

Question 682

What underlies AAA

Answer 682

chronic transmural inflammation

Question 683

how does pre-eclampsia damage organs?

Answer 683

widespread spasm

Question 684

The liver requires expression of APOE3 and APOE4 to take up what?

Answer 684

chylomicrons and VLDL's

Question 685

AIRE deficiency

Answer 685

without air your body would char | chronic mucocutaneous candidiasis, hypoparathyroidism, adrenal insufficiency, recurrent candida infection

Question 686

Wernicke's aphasia what artery

Answer 686

Inferior MCA. Broca's aphasia is superior MCA.

Question 687

Asthma small molecule bronchoconstrictors in pathogenesis

Answer 687

LTB C4, LTD4, LTE4 CDE's ends with e for eosinophils

Question 688

Meniere's disease triad

Answer 688

sensorineural hearing loss, vertigo, hearing loss. | Due to increased endolymph

Question 689

pinworm trx

Answer 689

albendazole, mebendazole, or pyrantel pamoate. The latter should be used in pregnant women.

Question 690

where does excess copper usually go?

Answer 690

bile

Question 691

cAMP utilizing hormones cause what?

Answer 691

activate protein kinase A

Question 692

immune cell types in COPD

Answer 692

macrophages, neutrophils, CD8 T cells

Question 693

What predisposes to giardia infection

Answer 693

any condition with low IgA. | Giardia looks like horse shoe crabs on slide

Question 694

Why do you have to take mefloquine for 4 weeks upon return from malaria endemic area?

Answer 694

Inactivated in the liver so cant fight schizonts in the liver

Question 695

Cytokine important in Giant cell arteritis?

Answer 695

IL-6 (the giant of inflammation) can be targeted with tocilizumab

Question 696

Raspuricase

Answer 696

Think Rasputin's big penis | oxidizes uric acid so it can be excreted in the urine

Question 697

Why are the acyclovir family of antivirals not universally effective?

Answer 697

many virus's can't convert the drugs to their active forms

Question 698

True vs false diverticula?

Answer 698

True diverticula- Merkel's all the layers | False diverticula- Zenker's mucosa and submucosa only

Question 699

Light's criteria

Answer 699

Protein ratio over .5 LDH ratio over .6 Pleural/serum

Question 700

postpartum pt with fecal incontinences nerve injured

Answer 700

pudendal

Question 701

UV light convers what part of vit D pathway

Answer 701

first step: 7-dehydrocholesterol to vit D3 (cholecalciferol)

Question 702

most deoxygenated blood in the body?

Answer 702

coronary sinus bc myocardial oxygen demand is so high

Question 703

Dementia meds that can cause AV block/syncope?

Answer 703

acetylcholinesterase inhibitors Donepezil and rivastigmine

Question 704

NRTI med specific mechanism

Answer 704

interfere with phosphodiester bond in growing strand

Question 705

what are P bodies?

Answer 705

CYTOPLASMIC structures important in mRNA translation regulation and decay

Question 706

most common cause of degenerative arthritis in back?

Answer 706

disk herniation, ligmentum flavum hypertrophy, and osteophyte formation

Question 707

Thiamine (Vit B1) def. syndromes

Answer 707

Wernicke-Korsakoff Wet/dry Beriberi

Question 708

life threatening hemoptysis in chronic lung dz

Answer 708

usually due to blood leak from high pressure hypertrophied bronchial arteries.

Question 709

Class III anti-arrhythmic drugs

Answer 709

``` AIDS Amiodarone (lipophilic class I,II,III activity) Ibutilide Dofetilide Sotalol ```

Question 710

Exercise and paO2 paCO2 venus and arterial system

Answer 710

everything in the arteriole system remains relatively constant. In the viens a lot more O2 is extracted and CO2 is produced

Question 711

How is it easiest to hear an S3

Answer 711

end of expiration bc it brings the heart closer to the chest wall

Question 712

Treatment for any generalized myoclonic or tonic clonic seizure?

Answer 712

Either Levetiracetam or valproic acid. Broad spectrum anticonvulsants.

Question 713

most specific and sensitive test for c. diff toxic strains

Answer 713

NAAT only drawback is it may identify asymptomatic carriers. ELISA is more sensitive but cant destinguish toxic vs nontoxic

Question 714

Regular rate tachycardia narrow QRS rhythm?

Answer 714

AVNRT. often affects young pts

Question 715

common microbes in septic abortion?

Answer 715

Staph aureus and E coli

Question 716

AA's in collagen

Answer 716

Glycine X-Y

Question 717

porcelain gallbladder assoc with what type of cancer?

Answer 717

gallbladder adenocarcinoma

Question 718

what embryologic layer makes spleen and blood vessles/blood

Answer 718

mesoderm

Question 719

what is a low volume of distribution and what does that mean

Answer 719

low is 3-5. Means the drug stays in the plasma well. This occurs if the drug has a high molecular weight, is highly charged, or binds to plasma proteins

Question 720

what is in-between vagina and anus cut during episiotomy

Answer 720

perineal body

Question 721

what is commonly affected in acute rhinositus?

Answer 721

the maxillary sinus gets all stuffed up bc it can't drain into the middle nasal meatus

Question 722

Didanosine side effect

Answer 722

DiDanosine causes pancreaDiDis

Question 723

Niacin moa in hypercholesterolemia?

Answer 723

antagonizes VLDL cholesterol secretion

Question 724

Family with righ Cholesterol, TG's and cholesterol with eruptive/itchy xanthoma's biochem issue?

Answer 724

Lipoprotein lipase or apoprotein C-II

Question 725

CNS damage stages

Answer 725

12-48hrs red shrunken neurons 1-3 days neutrophils and liquefactive necrosis 3-5 days macrophages (microglia) 1-2 weeks reactive gliosis and vascular changes 2 wks + glial scar

Question 726

Pie in the sky and pizza on the ground lobes

Answer 726

Pie in the sky is temporal lobe Meyers loop | pizza on the flor is parietal Baum's loop

Question 727

Genitalia and hormones male

Answer 727

Sertoli cells- anti-mullerian Hormone (no female internal) Leydig cells- Testosterone (male internal) 5-alpha reductase- DHT (male external)

Question 728

What are IL-2's anti tumor effects in high doses ?

Answer 728

activates NK cells (and its T cell effects as well)

Question 729

Propofol good and bad

Answer 729

Quick, decreases airway resistance | vasodilation, and increases TG's and lipase

Question 730

What do SLG2 inhibitors stop?

Answer 730

a glucose sodium symporter in the proximal tubule

Question 731

What happens to urine gravity in proteinuria

Answer 731

Urine becomes super concentrated so high gravity all due to 3rd spacing will loss of protein to keep stuff in

Question 732

Triad of botulism

Answer 732

dysphagia, diplopia, dysphonia (difficulty speaking)

Question 733

angiogenesis substances

Answer 733

VEGF and Fibroblast growth factor

Question 734

What muscles generate most intra-abdominal force during valsalva?

Answer 734

rectus muscles

Question 735

What cells does RCC carcinoma usually come from?

Answer 735

Proximal tubules. Most important and can cause Ca.

Question 736

what abducts arm over 100 degrees?

Answer 736

trap

Question 737

what activates trypsin?

Answer 737

enteropeptidase in the brush border

Question 738

Why fat in alcoholic liver dz?

Answer 738

lack of FA oxidation due to excess NADH

Question 739

Effects of adrenergic agonists

Answer 739

a1= (midodrine, nor and phenyl ephrine, dopamine high dose) Vasoconstriction B1: ( Dobuatmine) increased heartrate and output B2: (albuterol) vasodilation, bronchodilation D1= (fenoldopam, dopamine low dose) renal arteriolar vasodilation

Question 740

Transplant rejection type most likely to make a macopapular rash?

Answer 740

Graft vs Host disease

Question 741

Triglyceride breakdown 2 components

Answer 741

Glycerol: glycerol kinase (liver) can make substrates for gluconeogenesis Fatty acids: beta oxidation or ketogenesis

Question 742

Restless leg syndrome trx?

Answer 742

pramipexole a Dopamine agonist

Question 743

Filtration fraction?

Answer 743

GFR (from creatine) /RPF (from PAH) can use.. (urine conc x urine flow rate)/ plasma flow rate for both substances if only give Cr and PAH

Question 744

What drugs can be used if a cholinesterase inhibitor causes bad side effects? I.e treatment of MG

Answer 744

glycopyrrolate, hyoscyamine, propantheline | all selective muscarinic antagonists that don't interfere with therapy

Question 745

What part of Epinephrine synthesis requires cortisol/ACTH?

Answer 745

PNMT the final step to produce epinephrine from NorEpi

Question 746

pseudogout crystal makeup

Answer 746

calcium pyrophosphate (calcium that burns)

Question 747

cauda equina syndrome nerves?

Answer 747

S2-S4 pelvic splanchnic nerves. Parasympathetic

Question 748

intrapleural pressure at resting equilibrium?

Answer 748

-5 cm H2O

Question 749

what can be used as a marker of lung maturity in ammonitic fluid

Answer 749

Lecithin (phosphadylglycerol) increases Sphingomyelin decreases 2:1 or higher ration of L/S shows maturity

Question 750

Pigmented gallstone types

Answer 750

Black- hemolysis, enterohepatic bilirubin circulation | brown- chronic infection and microbial B-glucuronidase activity

Question 751

Ace inhibitors and interactions

Answer 751

NSAIDS- renal failure due to lowering of GFR in pts with previously poor function diuretics- first dose hypotension. So must start with low doses

Question 752

PCP moa

Answer 752

NMDA receptor antagonism

Question 753

What CN goes through the parotid gland?

Answer 753

Facial CNVII

Question 754

Neurophysins?

Answer 754

carrier proteins for oxytocin and vasopressin

Question 755

lower extremity lymph drainage

Answer 755

lateral- popliteal to superficial inguinal nodes (pop to the side) medial- directly to superficial inguinal nodes

Question 756

aldosterone normal function

Answer 756

increases Na/K ATPase pumps in collecting tube. promotes H+ and K secretion. Blocked by spironolactone

Question 757

how do systemic contraceptives work?

Answer 757

decrease GnRH secretion

Question 758

Where are anal fissures?

Answer 758

posterior midline distal to the dentate line. (line up with the butt crack)

Question 759

trx for opioid induced constipation without precipitating withdraw symptoms

Answer 759

methylnaltrexone

Question 760

best medical treatment for insomnia in older adults

Answer 760

Ramelteon a melatonin agonist

Question 761

Physiology of Factor V leiden Def.

Answer 761

Thrombosis bc the mutated factor 5 does not get degraded by protein C.

Question 762

What cells produce EPO?

Answer 762

Peritubular interstitial cells

Question 763

Important cell types in granulomas

Answer 763

TH 1 and TH17 | macrophages- become multinucleated giant cells

Question 764

Addison's disease (primary adrenal insufficiency)

Answer 764

low aldosterone- low BP, low Na and high K, skin pigmentation due to high ACTH production by pituitary low cortisol- low glucose, eosinophilia, anemia

Question 765

What does IgA protease do?

Answer 765

allows for attachment of bacteria to mucosal surfaces

Question 766

paraneoplastic cerebellar degradation

Answer 766

truncal ataxia and visual disturbances with and a tumor usually small cell or breast ca. Assoc with anti yo/hu/pq antibodies

Question 767

Ferguson bodies

Answer 767

asbestos particles

Question 768

High altitude and 2,3 BPG ?

Answer 768

Goes up to facilitate unloading of oxygen at tissues

Question 769

GI cancer genetic development sequence

Answer 769

APC mut- catenin accumulation. hyperplasia KRAS mut- adenoma p53- carcinoma

Question 770

Antifungal that targets cell wall

Answer 770

Caspofungin

Question 771

Antifungal that targets cell membrane

Answer 771

synthesis- azoles binders- nystatin, Amphotericin B

Question 772

antifungal that inhibits mitosis

Answer 772

Griseofulvin

Question 773

hypocalcemia symptom

Answer 773

muscle twitching

Question 774

Hairy cell leukemia vignette

Answer 774

MASSIVE splenomegaly, middle aged man, dry bone tap. TRAP

Question 775

occular side effects of PD-5 inhibitors

Answer 775

blue vision, ischemic optic neuropathy

Question 776

What cytokine is tied to neutrophil phagocytosis and pus formation

Answer 776

IL 8- (ate up the bacteria)

Question 777

What activates Azithropine?

Answer 777

HGPRT turns it to active 6-MP

Question 778

NF1 what are neurofibroma's composed of?

Answer 778

Schwann cells which are neural crest origin

Question 779

what does ureter obstruction do to GFR and FF?

Answer 779

Both decrease.

Question 780

antiviral pyrophosphate analog that does not require intracellular activation

Answer 780

foscarnet

Question 781

What nerves may be injured during lymph node removal for masectomy

Answer 781

intercostal brachial- pure sensory to medial upper arm long thoracic- serratus anterior thoracodorsal- latissimus dorsi medial pectoral- minor and major pec muscle

Question 782

How do Vit D analogues help in psoriasis?

Answer 782

activate a nuclear transcription factor resulting in decreased T cell and keratinocyte proliferation

Question 783

What nerve innervates the proximal arm flexors?

Answer 783

Musculocutaneous nerve C5-7 innervates bicep, brachialis, and coracobrachialis (makes baseball throwing throw cocked position). also sensory for lateral forearm

Question 784

Why do oral contraceptives and P make gallstones more likely?

Answer 784

Estrogen- cholesterol hypersecretion | Progesterone- gallbladder hypomobility

Question 785

embryologic connection between bladder and belly button that may persist?

Answer 785

Urachus

Question 786

If you cant use asprin for cardiovascular protection what is second line?

Answer 786

clopidogrel

Question 787

Treatment for urea cycle disorders?

Answer 787

low protein diet

Question 788

what other hormone can cause hyperthyroid symptoms by binding to the TSH receptor

Answer 788

When in huge excess (tumor) hCG can bind.

Question 789

Possible adverse effects of aggressive osmotic diuretic therapy to treat cerebral edema

Answer 789

Increased hydrostatic pressure can worsen CHF or cause pulmonary edema in those who already have excess pulmonary fluid

Question 790

prolonged exposure to loud noise damages what?

Answer 790

stereo ciliated hair cells of the organ of Corti

Question 791

Tertiary amine acetylcholinesterase inhibitors that can cross the BBB

Answer 791

physostigmine, galantamine, donepezil and rivastigimine

Question 792

ehrlichia on peripheral smear

Answer 792

morula (mulberry shaped intracytoplasmic inclusions in leukocytes)

Question 793

P's of Eosinophilic granulomatosis with Polyangiitis (churg-strauss)

Answer 793

``` Pale (atopic/ asthma) palpable purpura peripheral neuropathy Pauci immune glomerulonephritis p-ANCA/mPo-ANCA ``` granulomas

Question 794

Probability of finding a difference if one exists (study power equation)

Answer 794

power= 1-B | power is usually around 80%

Question 795

alpha/ beta errors

Answer 795

alpha risk-type 1 error = false positive | beta risk- type II error = false negative

Question 796

ribosomes and location

Answer 796

free floating- cytosolic, mitochondrial, peroxisome, and nucleolus proteins Rough ER associated- secreted proteins, membrane proteins and proteins within ER, Golgi and lysosome

Question 797

Pagets disease

Answer 797

enlarged head, fractures, bone deformities, pain/ hot areas, radiculopathy, hearing loss, lytic sclerotic lesions Only ALP is elevated

Question 798

How long can sperm be viable after vasectomy?

Answer 798

3 months or 20 ejaculations

Question 799

L5 radiculopathy symptoms

Answer 799

sensory lateral shin, dorsum of the foot | foot dorsiflexion, eversion, inversion, great toe extension

Question 800

Viral recombination vs reassortment

Answer 800

recombination- 2 non-segmented virus genetic exchange via crossing over reassortment- 2 segmented virus's via segMENT swapping. BOAR

Question 801

what causes zenker diverticulum?

Answer 801

cricopharyngeal muscle dysfunction (innervated by vagus nerve)

Question 802

meds that can cause SIADH

Answer 802

Carbamazepine , SSRI's , NSAID's

Question 803

Trochanteric bursitis (Greater trochanteric pain syndrome) occurs at insertion of what?

Answer 803

Gluteus minimums and Medius | G's for greater trochanteric

Question 804

What cells form the fibrous cap in atherosclerosis?

Answer 804

migrated smooth muscle cells that secrete extracellular matrix

Question 805

Why hypotension in tension pneumothorax?

Answer 805

increased pressure causes vena cava to collapse

Question 806

What vitamin is required for specialized epithelium differentiation?

Answer 806

Vitamin A

Question 807

Drugs that target the PD-L on T cells to prevent T cell exhaustion and continued battle against cancer?

Answer 807

pembrolizumab, nivolumab, atezolizumab

Question 808

Isoniazid side effects?

Answer 808

neuropathy, hepatotoxicity, drug induced lupus

Question 809

POMC can form what hormones

Answer 809

endorphins, ACTH, MSH

Question 810

what happens to phosphate during refeeding syndrome

Answer 810

increased insulin due to carbs causes phosphate to move into muscle and and the liver for ATP production

Question 811

Niacin (B3) and biochemistry

Answer 811

Part of NAD/NADH needed in many dehydrogenase and redox enzymes. Tons of dehydrogenase enzymes of the TCA cycle require this vitamin

Question 812

what can chronic hemolysis do to the kidney

Answer 812

Hemosiderosis (iron deposition)

Question 813

what enzyme in DNA synthesis catalyzes the formation of RNA strands

Answer 813

primase. remember uracil is only found in RNA

Question 814

NK-1 antagonists

Answer 814

end in "pitant" used for chemo induced nausea. can cause neutropenia

Question 815

phrenic nerve pain is referred where?

Answer 815

shoulder

Question 816

Releasing factors?

Answer 816

recognize stop codons, UGA, UAA, UGA

Question 817

Who is at high risk of vibrio vulnificus?

Answer 817

Iron overloaded pts or those with hepatic damage

Question 818

arsenic poisoning

Answer 818

galicy breath, severe watery diarrhea. May be found in insecticides. Dimercaptol is firstline treatment

Question 819

osteosarcoma

Answer 819

lytic lesion on x-ray. usually in metaphysis. bone, osteoid and spindle cells

Question 820

What breaks down 6-MP?

Answer 820

Xanthine oxidase and thiopurine methyltransferase which is genetically depressed in up to 12% of the population

Question 821

Why are old ppl bad at breathing in high altitude?

Answer 821

1. decreased chest wall compliance 2. decreased alveolar elastic recoil 3. increased a-a gradient and v/q mismatching

Question 822

primary hypothyroidism

Answer 822

TSH: High. telling to make more thyroid T4: low. thyroid not working T3: usually normal. small amount anyways and not made until at the tissue

Question 823

ovarian tumor that secretes thyroid hormone?

Answer 823

struma ovarii. a germ cell tumor that causes hyperthyroidism symptoms

Question 824

why do old people have yellow/brown intracellular spots on autopsy?

Answer 824

lipid peroxidation, especially those who are malnourished before death

Question 825

Wecner's polyangiitis path description?

Answer 825

necrotizing arteritis and epithelioid histocytes

Question 826

eosinophilic polyangiitis path description

Answer 826

necrotizing granuloma's with eosinophilic predominance

Question 827

what vessels are most susceptible to atherosclerosis?

Answer 827

lower abdominal aorta and then coronary arteries

Question 828

pulmonary alveolar proteinosis

Answer 828

macrophages cant clear surfactant. Surfactant goops up into lamellar bodies

Question 829

Milrone

Answer 829

PDE 3 inhibitor used in refractory systolic HF - positive inotrope - vasodilation

Question 830

which Histone molecule is on the outside of and packs in the wrapped DNA

Answer 830

H1

Question 831

failed femoral catheterization above the inguinal ligament where does the blood go

Answer 831

retroperitoneal space

Question 832

Trendelenburg gait after IM injection

Answer 832

superior gluteal nerve in superior medial quadrant of the buttock was injured

Question 833

nerves of carotid sinus hypersensitivity

Answer 833

afferent- glossopharyngeal IX | efferent- Vagus X

Question 834

propranolol and thyroid hormone

Answer 834

decreases adrenergic effects of thyroid hormone and decreases peripheral T4 to T3 conversion

Question 835

Common Poisoning that causes oxalate crystals and AKI

Answer 835

ethylene glycol its metabolites include oxalate and other renal toxins. Fomepizole prevents degradation to toxic metabolites

Question 836

common cause of multiple small hemorrhagic strokes in the elderly?

Answer 836

cerebral amyloid angiopathy

Question 837

supracondylar humoral fracture potential injuries

Answer 837

If displaced portion moves laterally- radial nerve | If displaced portion moves medially- median nerve brachial artery

Question 838

what happens to chest wall with pneumothorax?

Answer 838

springs outward as there is no longer negative pressure pulling it in

Question 839

Specific B cell surface proteins

Answer 839

CD 19,20,21

Question 840

treatment for age related macular degeneration?

Answer 840

VEGF inhibitors

Question 841

metronidazole + alcohol

Answer 841

disulfiram like rxn

Question 842

Testosterone receptor inhibitors

Answer 842

flutamide, cyproterone, spironolactone to some degree

Question 843

MI and timeline of ischemia

Answer 843

takes only 60S for area of affected myocardium to stop beating. within 30+ minutes damage may be irreversible

Question 844

proximal lymph drainage

Answer 844

internal Iliac nodes

Question 845

HIV in CNS

Answer 845

preferentially replicates and infects macrophages

Question 846

death cap mushroom mech

Answer 846

halts mRNA synthesis in the liver

Question 847

where does coronary sinus drain?

Answer 847

right atrium

Question 848

male androgen cells

Answer 848

Leydig (outside)- LH responsive makes Testostrone | Sertoli (inside tubule- FSH responsive makes androgen binding Hormone and inhibin B

Question 849

how does hyper ammonia cause CNS symptoms?

Answer 849

increases glutamine which disrupts Glutamate release and disrupts excitatory neurotransmission

Question 850

Isoniazid can deplete what hormone?

Answer 850

B6 (pyridoxine)

Question 851

what vessel provides blood to the femoral head?

Answer 851

medial circumflex artery

Question 852

Why wipe out CD3 + cells before a marrow transplant?

Answer 852

reduce graft vs host dz

Question 853

ganciclovir side effects

Answer 853

can cause neutropenia, thrombocytopenia or anemia

Question 854

G6PD converts what to what?

Answer 854

G-6-P to 6 phosphogluconate

Question 855

Treatments for idiopathic pulmonary fibrosis?

Answer 855

Drugs that target growth factors

Question 856

Hypothalamic nuclei

Answer 856

Ventromedial- satiety. VentromediFULL Lateral- hunger, Fatterall Anterior- heat dissipation. AC posterior- heat conservation, your 'posterior is hot' arcuate- dopamine medial preoptic- GnRH 'gonads are modestly optical' paraventricular- oxytocin PAIRaventricular Supra optic- ADH look up to see water/rain suprachiasmatic- sleep. Charismatic if you get enough sleep

Question 857

Non sedating antihistamine agents?

Answer 857

loratadine, cetirizine. Use in the elderly

Question 858

What comonent of FA synthesis inhibits beta oxidation?

Answer 858

malonyl coA

Question 859

contrast induced nephropathy path findings?

Answer 859

proximal tubule necrosis. may have muddy casts

Question 860

Breathing speed and obstructive/restrictive

Answer 860

obstructive- lowest work when breath slow | restrictive- lowest work when breathing fast

Question 861

hemorrhagic pancreatitis on path description

Answer 861

chalky white fat necrosis with interspersed areas of hemorrhage

Question 862

Large VSD cardiac pressures?

Answer 862

RA: unchanged | everything else increased due to intraventricular equalization and increased flow through pulmonary circulation

Question 863

Xanthelasma

Answer 863

lesions around the eye filled with lipid laden macrophages . Signals high serum lipids possible biliary obstruction

Question 864

exact missense error in sickle cell

Answer 864

normal GAG to a GTG switches glutamic acid to valine

Question 865

what bacteria besides Pseudomonas and s. aureus are cystic fibrosis pts at risk for

Answer 865

non-typeable H-flu and Burkholderia

Question 866

loss of vagus nerve gastric consequences?

Answer 866

low HCL and delayed gastric emptying/gastroparesis

Question 867

Bluish lesion under nailbed differential

Answer 867

1. Melanoma | 2. glomus tumor (proliferation of small surface vessles important in thermo regulation)

Question 868

first vs zero order kinetics

Answer 868

first order- same rate of metabolism with differing dose | zero order- diminishing rate of metabolism with higher doses

Question 869

What innervates the tensor tympani

Answer 869

Mandibular nerve (V3 of trigeminal nerve) causes muffled hearing +/- ear pain in injured

Question 870

Where do you sample to get a diagnostic biopsy of Hirshprung's disease?

Answer 870

submucosa of the rectum

Question 871

How does sodium bicarb infusion help in salicylic poisoning

Answer 871

reduces protonated form by lowering PH so it cant enter tissues and is excreted in the urine

Question 872

low intravascular oncotic pressure does what to lipoproteins

Answer 872

increases lipoprotein production in the liver and decreased lipoprotein catabolism

Question 873

Priapism medical treatment

Answer 873

a1 adrenergic agonist injection

Question 874

lidocaine MOA

Answer 874

blocks voltage gated sodium channels from inside the neuron

Question 875

What cells secrete hepcidin?

Answer 875

hepatic parenchymal cells

Question 876

Distal Clavicle fracture why is it displaced

Answer 876

Distal fragment goes down due to pull of deltoid | proximal fragment goes up due to trap and sternocleidomastoid pull

Question 877

Phenotypic mixing?

Answer 877

When a coinfected cell contains viruses that share surface protein but do no alter their genetics so viral progeny will not have mixed surface proteins.

Question 878

what are the superficial and deep inguinal rings covered by?

Answer 878

superficial- external oblique aponeuroses | deep- transversalis fascia

Question 879

Why do old people have poorer response to vaccines?

Answer 879

Less naïve T and B cells

Question 880

What cells only go though glycolysis but sometimes produce no ATP?

Answer 880

erythrocytes can corm 2,3 BPG with intermediates instead of energy on some rounds of the rxn

Question 881

pancreatic pseudocyst?

Answer 881

occurs weeks after pancreatitis. PSEUDOcyst bc it is lined by fibrous tissue rather than epithelial cells

Question 882

Systemic mastocytosis ?

Answer 882

Monoclonal proliferation of mast cells. Histamine release = flushing, itching (especially after showers) and gastric acid secretion. assoc with KIT mutations. Kit Herron has rosy cheeks!

Question 883

Charcot vs berry aneurysm?

Answer 883

charcot- intraventricular hemorrhage | Berry/saccular- subarachnoid hemorrhage

Question 884

what opiod can precipitate withdraw symptoms in a chronic user?

Answer 884

buprenorphine

Question 885

Cause of most isolated systolic htn

Answer 885

age related stiffness of arteries

Question 886

What electrolyte is important in metabolic alkalosis

Answer 886

urinary Cl level because it can impair renal excretion of HCO3

Question 887

C1 cleaves what?

Answer 887

C4 so these levels will be low inhibitor def

Question 888

Subacute granulomatous thyroiditis (de quervian) vs Hashimoto's thyroiditis

Answer 888

De quervian: transient hyperthyroid, follows infection, painful. macrophages and giant cells. high ESR/CRP Hashimoto's: autoimmune, painless, hypothyroid dominant. lymphocyte infiltrate with germinal centers. Hurthle (eosinophilic epithelial) cells

Question 889

Henoch-Schonlein purpura (Ig A vasculitis) on biopsy

Answer 889

Ig A immune complex deposition with neutrophilic perivascular damage

Question 890

What abx has MAOI activity and can cause serotonin syndrome

Answer 890

linezolid

Question 891

What can cause opioid overdose in a methadone therapy pt?

Answer 891

any p450 inhibitor

Question 892

What myopathy causes normal strength but delayed reflexes?

Answer 892

hypothyroid myopathy

Question 893

What enzyme turns heme into biliverdin?

Answer 893

heme oxygenase

Question 894

What kind of drugs are dose adjusted based on 'ideal' body weight?

Answer 894

Hydrophilic drugs that are limited to the extracellular fluid compartment

Question 895

what causes strictures in crohn's

Answer 895

thickened muscularis mucosa

Question 896

which adrenergic receptors are found in eye and uterus?

Answer 896

eye- alpha 1 | uterus- beta 2

Question 897

What are the two most important buffers that the body uses to safely excrete H+

Answer 897

HPo4 and NH3

Question 898

What features of a drug make it more likely to be hepatically cleared

Answer 898

Highly lipophilic drugs with high volumes of distribution

Question 899

Phospholipase A2 antibodies?

Answer 899

assoc with membranous nephropathy

Question 900

Hereditary hemorrhagic telangiectasia symptoms?

Answer 900

TGF-B signaling issue. Telangiectasia, nosebleeds, organ AVM's. High output HF, pulmonary HTN, paradoxical emboli and Iron deficiency are complications

Question 901

refractory urge incontinency treatment?

Answer 901

stimulation of S3

Question 902

Vaptans?

Answer 902

Act on V2 and treat hyponatremia by causing water diuresis without affecting K or Na excretion

Question 903

Klinefelter's

Answer 903

XXY, long legs, gynecomastia, sparse facial hair. No sperm High FSH, LH tying to stimulate dysfunctional Sertoli and Leydig cells

Question 904

What disease is assoc with renal angiomyolipomas?

Answer 904

Tuberous sclerosis

Question 905

Homebox or Hox genes usually code for what?

Answer 905

transcription factors

Question 906

Patiromer

Answer 906

Exchanges Ca to bind K in the intestine. A slow acting treatment for hyperkalemia

Question 907

Why can ethanol consumption causes hypoglycemia

Answer 907

decreased pyruvate and oxaloacetate required for gluconeogenesis in the liver

Question 908

FEV1/FVC ratio in COPD?

Answer 908

Decreased

Question 909

Neutrophil invasion steps

Answer 909

Margination: improved contact with wall Rolling: sialyl Lewis X on neutrophils and P/E selectins on wall Activation: Integrins start to get expressed Tight adhesion: CD18 integrins and ICAM Transmigration: PECAM

Question 910

Adenosine side effects

Answer 910

AV block Flushing. hypotension Bronchospasm

Question 911

class of diuretics that can cause hearing loss

Answer 911

Hoop earings (loop)

Question 912

What do you monitor in ankylosing splondylitis?

Answer 912

chest wall expansion

Question 913

Granulosa cell tumor on histology?

Answer 913

Call-Exner bodies (Cuboidal cells in a rosette pattern with coffee bean nuclei)

Question 914

Medulloblastoma vs pilocytic astrocytoma?

Answer 914

Both childhood tumors in cerebellum Medulloblastoma- malignant, solid, small cells, cells surrounding neurophil Pilocystic astrocytoma- cystic and solid components, GFAP +, eosinophilic cytoplasmic inclusions (rosenthal fibers)

Question 915

3' end of T-Rna molecule

Answer 915

CCA tail T loop helps binding to ribosome D loop helps proper tRNA synthetase recognition

Question 916

What drug should be given to pts requiring chronic blood transfusions?

Answer 916

Deferoxamine. Helps bind iron to prevent CHF from iron overload

Question 917

What test is more specific than karyotyping for the diagnosis of large duplications/ translocations or deletions?

Answer 917

FISH

Question 918

Disease that involves loss of internal elastic lamina?

Answer 918

fibromuscular dysplasia

Question 919

Ribs overlying spleen/liver and kidney

Answer 919

spleen/liver- 9-11th ribs | kidney- 12th rib

Question 920

Myofibril layers

Answer 920

ZAM Z line Actin (light) Myosin (heavy) middle darker

Question 921

Leukoclastic vasculitis

Answer 921

neutrophil predominant vasculitis with purpura. Due to drug reaction. often abx or allopurinol

Question 922

Retinitis pigmentosa?

Answer 922

genetic issue First loss of rods- peripheral vision/night blindness then loss of cones- central vision loss

Question 923

What does chronic heavy use of NSAIDs do to kidney

Answer 923

Chronic interstitial nephritis- shriveled kidneys and/or papillary necrosis- infarcts

Question 924

terbinafine antifungal mech?

Answer 924

Inhibits Squalene epoxidase

Question 925

McArdle dz

Answer 925

loss of myophosporylase and muscles cant break down glycogen | myoglobin in urine after exercise, muscle pain, cramping

Question 926

Baby extracranial head bleeds

Answer 926

subgleal- crosses suture lines. BTW periostea and galea aponeuroses cephalohematoma- btw skull and periosteum

Question 927

polycistronic mRNA

Answer 927

one mRNA codes for multiple genes common in prokaryotes. ie lac operon is one such gene

Question 928

vascular smooth muscle and phosphorylation

Answer 928

phosphorylated lc- contracted | dephosphorylated lc- relaxed

Question 929

normal P with delivery then a mole. What happened?

Answer 929

proliferation of trophoblasts

Question 930

What does pathology in brain look like in Rett syndrome

Answer 930

MECP2 gene. loss of brain development rather than signs of neuronal death

Question 931

Feared cause of death in ALS

Answer 931

diaphragmatic atrophy

Question 932

SIADH urine sodium?

Answer 932

becomes high as BNP and ANP ramp up to prevent frank volume overload

Question 933

Whipple Dz

Answer 933

``` Loose stool, abd pain, weight loss. Gram + actinomycete PAS (visualizes cell gylcoproteins) + Diastase resistant Pass the foamy whipped cream CAN (cardiac, arthralgia, neuro) ```

Question 934

Benign liver tumors

Answer 934

hepatic adenoma- can regress with contraceptive dc | hepatic cavernous hemangioma- most common. big caverns with vessles on histology

Question 935

Barorecpetor reflex signaling

Answer 935

Usually M3 causes decreased cAMP in myocytes decreased B1 and increased M2 cause decrease depolarizing Ca in SA node all in response to increased BP

Question 936

Hypothyroidism and galactorhea?

Answer 936

High TRH can stimulate lactotrophs

Question 937

repetitive screwdriver use injury

Answer 937

radial nerve injury (usually finger extension without full wrist drop) due to repetitive contact with supinator muscle

Question 938

What stimulates firs step of gluconeogenesis?

Answer 938

High Acetyl CoA tells rxn to make more glucose

Question 939

water soluble drugs in neonates

Answer 939

need more of it to get same volume of distribution bc neonates have more relative total body water content.

Question 940

cyanide tox treatments

Answer 940

1. Sodium Thiosulfate- donates sulfur for detox 2. Sodium nitrate- induces methemoglobin 3. hydroxocolabumin- binds cyaninde ions

Question 941

Opiod binding on mu receptor effects

Answer 941

Presynaptic CNS neuron- block Ca influx so no neurotransmitter release postsynaptic spinal neurons- influx of K hyperpolarizing the cell

Question 942

buserelin and bicalutamide dual therapy?

Answer 942

Buserelin- GnRH analogue | Bicalutamide- blocks initial GnRH surge

Question 943

Homocysteinuria trx

Answer 943

High dose vit B6 (pyridoxine) | avoid methionine

Question 944

Why is some proteinuria (<300mg/24h) normal in P

Answer 944

Increased GFR, decreased reabsorption and increased permeability

Question 945

embyologic products of the vilintine veins and cardinal veins

Answer 945

villintine- portal system | cardinal- systemic venus system

Question 946

Where does ablation for A-flutter target?

Answer 946

aria btw tricuspid valve and IVC in RA

Question 947

Hawthorne effect

Answer 947

acting better bc you are being studied

Question 948

What innervates posterior portion of external ear canal?

Answer 948

Vagus nerve

Question 949

Cellular staging of oocytes

Answer 949

during childhood- arrested in Prophase of Meiosis 1 Menses- Some eggs complete Meiosis 1 Fertilized egg- arrested in metaphase of Meiosis 2 just before union with sperm

Question 950

PURE red cell aplasia associations

Answer 950

1. Parvovirus | 2. systemic dz (often thymoma)

Question 951

Trx for removal of parathyroid gland

Answer 951

oral calcium and calcitriol (active Vit D)

Question 952

Hypersensitivity pneumonitis on biopsy

Answer 952

Poorly formed noncaseating granulomas, lymphocytes, septal fibrosis

Question 953

Early CVD and tendon xanthomas/Xanthelasmas Defect?

Answer 953

LDL receptor or ApoB-100. elevated LDL in serum

Question 954

Early CVD + Peripheral VD. Palmar Xanthomas. Defect?

Answer 954

APO E. elevated circulating VLDL and chylomicrons

Question 955

Acute pancreatitis + itchy skin xanthomas, hepatosplenomegaly. Defect?

Answer 955

lipoprotein lipase or APO C. high chylomicrons "Itchy pancreatitis due 2 lipase"

Question 956

False negatives on urea breath test for H-Pylori

Answer 956

anything that suppresses growth but does not kill. abx, PPI's or bismuth

Question 957

Mid diastolic murmur + hemoptysis in immigrant

Answer 957

Mitral stenosis can cause hemoptysis via high pressure of bronchial veins

Question 958

Histology difference btw lipoma and liposarcoma?

Answer 958

liposarcomas have scalloping/ indentations

Question 959

Alcoholic cerebellar dysfunction vs. mamillary body damage

Answer 959

cerebellar vermis dysfunction- truncal instability, wide based gate +/- tremor Mamillary body damage- Wernicke presents as triad of ataxia, encephalopathy, horizontal nystagmus

Question 960

Calcineurin inhibitors side effects

Answer 960

Tacrolimus and cyclosporine can cause renal damage.. Decrease IL-2 gene transcription

Question 961

In PCR what direction does Taq polymerase work?

Answer 961

5-3

Question 962

where do intestinal epithelial stem cells reside?

Answer 962

crypts of Lieberkuhn

Question 963

What cells are in cirrhotic nodules?

Answer 963

hepatocytes stellate cells just make fibrosis (TGF-B)

Question 964

What antibiotics bind the 23S pocket of the bacterial 50s ribosome subunit?

Answer 964

The clorox clean prince Linezolid of the macro 50s ribosome! | Macrolides and clindamycin specifically bind at the 23S pocket

Question 965

cystic hygromas?

Answer 965

transilluminating cysts usually on left head or neck associated with trisomy's and turner syndrome

Question 966

why would a neuronal action potential that used to go to +40mv now only go to +10mv?

Answer 966

decreased sodium conc. outside the cell

Question 967

what gland is particularly sensitive to radiation exposure?

Answer 967

Thyroid. Papillary and follicular cancers specifically. Give potassium Iodide prophylactically in case of significant radiation exposure

Question 968

Why does tardive dyskinesia develop?

Answer 968

upregulation of dopamine receptors in respose to chronic antipsychotic use

Question 969

What do cancer cells do in a petri dish

Answer 969

cover the whole thing then make mounds bc they lack catenin and cadherin mediated contact inhibition

Question 970

midshaft humerous fracture. what nerve?

Answer 970

radial

Question 971

Skewed X inactivation

Answer 971

refers to women who do not evenly inactivate X chromosomes across thier cells

Question 972

Filtration fraction in a stenotic kidney?

Answer 972

``` Filtration fraction (GFR/RPF) increases bc GFR is saved (afferent dilates, efferent constricts) RPF is sacrificed. So FF is a higher number ```

Question 973

Psoriasis pathology

Answer 973

hyperkeratosis and epidermal hyperplasia. | Due to DENDRITIC cells recruiting helper T-cells.

Question 974

Venous drainage above the dentate line

Answer 974

Superior rectal > inferior mesenteric > portal venous system. This is why lesions above the dentate line often metastasize to the liver. Below the dentate line often metastasize to the lungs

Question 975

trx for old people with dry skin in the winter

Answer 975

moisturize after bathing

Question 976

why use probenecid with penicillin G?

Answer 976

increases concentrations by inhibiting renal tubular secretion. (can also be used to increase uric acid exertion)

Question 977

tetracycline teratogenic effect

Answer 977

slow bone formation and destroy tooth enamel

Question 978

mech of post cough or valsalva syncope?

Answer 978

decreased venous return to the heart due to increased intrathoracic pressure

Question 979

bloom syndrome

Answer 979

DNA helicase issue. | Photosensitivity, short stature, telangiectasias. predisposed to lymphoma and GI ca.

Question 980

complication of endometriosis?

Answer 980

infertility

Question 981

In collagen synthesis hydroxylation and glycosylation is important for what step?

Answer 981

Triple helical procollagen formation

Question 982

uncal (medial most segment of the temporal lobe) herniation sign?

Answer 982

CN III palsy making a ipsilateral fixed dilated pupil

Question 983

microsatellite instability?

Answer 983

microsatellites are areas of repeated units. They are especially vulnerable if mismatch repair enzymes are not working as in lynch syndrome.

Question 984

Dacubitrol valsartan therapy

Answer 984

neprilysin inhibitor increases ANP/BNP and blocks aldosterone production ARB blocks remaining aldosterone at the receptor. Angiotensin II is elevated but cant increase aldosterone

Question 985

HLA subtypes that do not mount an effective IgG response? What happens

Answer 985

improper antigen presentation and no T cell response with is heavily dependent on IgG

Question 986

ARDS physiology

Answer 986

fluid filled aveoli still get perfusion. Causes a V/Q mismatch and right to left physiologic shunting

Question 987

Where does Kayser-Fleischer ring deposit in the eye?

Answer 987

Descemet membrane of the cornea

Question 988

Dysplastic nevus syndrome genetics

Answer 988

9p21 chromosome. CDKN2A gene. predisposes to melanoma.

Question 989

leucine zipper?

Answer 989

transcription factors that have two alpha helixes rich in leucine c-jun and c-fos are examples

Question 990

How do G-protein coupled receptor work

Answer 990

PIP3 > DAG > protein kinase C > calcium release and protein phosphorylation

Question 991

First step of purine synthesis?

Answer 991

Carbamoyl phosphate synthetase II combines CO2, glutamine and ATP in the cytosol

Question 992

what does leg raise in appendicitis test?

Answer 992

peritoneal irritation against the psoas (on the groove of the vertebrae then goes toward groin)

Question 993

How do retinoids work for acne

Answer 993

1. Decreased epithelial cohesiveness. 2. increased turnover, 3. normalizes keratinization

Question 994

What enzyme is def in a normal weight/ young pt with elevated blood glucose level (mild DMII)

Answer 994

glucokinase in the pancreas leading to higher setpoint before insulin is released.

Question 995

Pontine hemorrhages

Answer 995

fixed pinpoint pupils loss of horizontal gaze, decerebrate (extensor posturing) death in hours

Question 996

the brain: cytotoxic edema vs vasogenic edema

Answer 996

cytotoxic- usually ischemia (due to ATP dependent pumps malfunctioning) vasogenic- often tumors

Question 997

reactive arthritis triad

Answer 997

cant see, cant pee, cant bend my knee

Question 998

types of cells in cervical transitional zone?

Answer 998

simple columnar epithelium and simple stratified squamous epithelium

Question 999

Sleep Stages

Answer 999

BATS Drink Blood B- Awake A- Awake eyes open T- Theta N1 light sleep Spindles/ K complex N2, bruxism Delta- bedwetting night terrors, sleepwalking Beta- REM sleep, erections, dreams/nightmares, muscle paralysis

Question 1000

What becomes an essential AA in PKU?

Answer 1000

Tyrosine

Question 1001

Hallmark of TB meningitis on autopsy?

Answer 1001

Thick grey exudate on base of brain. Usually subacute, includes vasculitis

Question 1002

Is diabetic diarrhea a thing?

Answer 1002

Yes. Secritory Persists with fasting (even at night) due to autonomic bowel dysmotility.

Question 1003

How do stimulants work?

Answer 1003

Block NE and D reuptake

Question 1004

What combats hyperphosphatemia and too much vit D?

Answer 1004

Fibroblast growth factor 23 for when your GRF is 23!!! Released by osteocytes

Question 1005

what cells produce elastase?

Answer 1005

alveolar macrophages

Question 1006

What nerves can be injured during prostatectomy?

Answer 1006

prostatic plexus (inferior hypogastric nerves and + pelvic and splanchnic nerves) This contains nerves that innervate the corpus leading to erectile disfunction

Question 1007

Injury location of median nerve signs + whole lateral palm is numb

Answer 1007

proximal to palmar branch of median nerve often compression by the pronator teres

Question 1008

2 associations of non-bacterial endocarditis

Answer 1008

technically any hypercoagulable state but especially Lupus and Advanced malignancy

Question 1009

Klienfelters hormones

Answer 1009

Low Testosterone, high estradiol | High FSH and LH due to lack of negative feedback

Question 1010

Why is sputum green with pneumonia?

Answer 1010

neutrophils releasing myeloperoxidase turns it green

Question 1011

What antiemetics are used in motion sickness nausea

Answer 1011

``` anticholinergics (scopolamine) anti histamines (promethazine is clutch in hyperemesis gravidarum) ```

Question 1012

acetazolamide and urine K

Answer 1012

Promotes excretion of potassium

Question 1013

Where are B1 receptors found?

Answer 1013

juxtaglomerular cells (this is why B blockers decreases renin) and cardiac muscle. Not in the vasculature

Question 1014

What drugs is HIV 2 immune too naturally

Answer 1014

NNRTI's, fusion inhibitors

Question 1015

Cells important in Sarcoidosis

Answer 1015

Macrophages (convert active vit D and secrete Ace) | CD 4+ T cells (secrete TNF-a / INFN Gamma to activate macrophages)

Question 1016

Why don't selective arteriolar vasodialators work as longterm monotherapy for HTN?

Answer 1016

hydralazine and minoxidil dont work alone bc 1. sympathetic reflex tachycardia 2. RAS activation making them bad longterm

Question 1017

alcoholic + chelitis, glossitis what is deficient

Answer 1017

Vit B2 (riboflavin) FAD is needed for succinyl dehydrogenase in the TCA cycle

Question 1018

humoral neck fracture complication

Answer 1018

Avascular Necrosis

Question 1019

chronic alcohol use and receptors

Answer 1019

less GABA more glutamate NMDA receptors. The latter is responsible for excitatory symptoms of withdraw

Question 1020

duodenal ulcer posterior wall can erode into what?

Answer 1020

gastroduodenal artery

Question 1021

what is analogous to EC50 for inhaled anesthetics. measure of potency

Answer 1021

MAC. Mean alveolar concentration. lower is more potent

Question 1022

Spermatic cord mnemonic

Answer 1022

ICE TIE Internal s. fascia- transversalis fascia Cremasteric muscle & fascia- internal oblique External spermatic fascia- external oblique (Orchiplexy for non descended testicle pulls it through this)

Question 1023

Diabetic most common mononeuropathy

Answer 1023

CNIII ischemic

Question 1024

Over 24hrs without food how does glucose stay steady?

Answer 1024

Gluconeogenesis utilizing glucogenic AA's to make oxaloacetate and convert it to posphopenyl pyruvate

Question 1025

Normal cardiac changes with aging

Answer 1025

lipofuscin, shortened length, decreased ventricular cavity size, sigmoid septum, dilated aortic root

Question 1026

Chikungya fever

Answer 1026

southern hemisphere, severe arthralgia/arthritis, lymphopenia, alpha virus, transmitted by Aedes mosquito (same as zika)

Question 1027

Crohn's or UC which has granulomas?

Answer 1027

Crohn's has granulomas

Question 1028

elevation of testicle feels better for what dz?

Answer 1028

epididymitis

Question 1029

ichthyoses vulgaris

Answer 1029

"fish scale disease" due to filaggrin mutation. ineffective desquamation

Question 1030

Tongue sensation

Answer 1030

anterior sensation 2/3 Trigeminal V3 mandibular anterior taste 2/3 Facial nerve posterior sensation + taste 1/3 glossopharyngeal

Question 1031

mixture of normal and abnormal cells what kind of mosaicism?

Answer 1031

somatic mosaicism

Question 1032

Fas ligand?

Answer 1032

Helps self reactive T cells undergo apoptosis

Question 1033

drunk colleague working?

Answer 1033

contact supervisor ASAP

Question 1034

RAS active state vs inactive

Answer 1034

GDP inactive | GTP active

Question 1035

Right sided ascending vs Left sided descending colon cancers

Answer 1035

RT-ascending (larger), occult fatigue, iron deficiency LT- descending (smaller) constipation obstruction rectal- tenesmus, small caliber stools

Question 1036

Best drug for bulimia nervosa?

Answer 1036

fluoxetine

Question 1037

Why are immature RBC's blue after Wright Giemsa stain?

Answer 1037

Residual ribosomal RNA

Question 1038

Why give ACE inhibitors after MI?

Answer 1038

prevents left ventricular chamber dilation

Question 1039

Mechanism of duloxetine, nortriptyline for neuropathic pain?

Answer 1039

decreased serotonin and NE release

Question 1040

Haldane and Bohr effect of Hgb?

Answer 1040

Haldane- to accept more oxygen heme releases H+ and CO2. In lungs Bohr- to accept CO2 more H+ is created and oxygen is released. In tissue

Question 1041

Golgi Tendon organ?

Answer 1041

negative feedback to prevent muscles from exerting too much force

Question 1042

Why do we get wrinkles?

Answer 1042

Decreased collagen fibril production and up regulated metalloproteases

Question 1043

leishmania

Answer 1043

intracellular parasite transmitted by sand fleas. Are oval and have a rod shaped kinoplast.

Question 1044

Theophylline intoxication

Answer 1044

seizures and tachy arrhythmias. TRx usually includes benzos or barbiturates

Question 1045

cholangiocarcinoma on biopsy

Answer 1045

adenocarcinoma with mucin production and desmoplastic response

Question 1046

What vitamin is a cofactor in AA transamination and decarboxylation reactions?

Answer 1046

B6 (pyridoxine)

Question 1047

cystic fibrosis restrictive or obstructive?

Answer 1047

obstructive due to a mutated ATP activated chloride channel

Question 1048

Acute intermittent porphyria treatment

Answer 1048

Heme infusion, decreases ALA accumulation and so porphobilinogen accumulation is not enough to cause attacks and symptoms are controlled

Question 1049

mech of hydrocephalus in sub arachnoid hemorrhage?

Answer 1049

blood blocks CSF absorption

Question 1050

reactive neutrophils on blood smear?

Answer 1050

Dohle bodies (peripheral tiny blue cytoplasmic inclusions

Question 1051

interstitial nephritis vs tubular necrosis

Answer 1051

white blood cell casts vs granular "muddy" casts

Question 1052

what vessles may bleed in diverticulosis?

Answer 1052

vasa recta

Question 1053

oral pharyngeal cancer and nerve compression?

Answer 1053

base of tongue- glossopharyngeal | back of throat- vagus

Question 1054

geneticly inherited RB mutation cancers

Answer 1054

retinoblastoma and osteosarcoma | The worst retinal and bone cancers

Question 1055

Glaucoma meds and inflow/ outflow

Answer 1055

less inflow: beta blockers, alpha 2 agonists, carbonic anhydrase inhibitors more outflow: prostaglandin agonists, muscarinic agonists

Question 1056

Why is Hep B genetically unstable?

Answer 1056

lacks 3-5 exonuclease proofreading

Question 1057

B-thalassemia genetic issue?

Answer 1057

abnormal transcription or translation of mRNA

Question 1058

abciximab

Answer 1058

blocks platelet IIb/IIIa binding to fibrin.

Question 1059

Glucagonoma

Answer 1059

Often affects insulin resistant/ DM. | migratory necrolytic erythema and tons of skin symptoms. often affect groin, face or extremities

Question 1060

Cremasteric and anal wink reflex roots

Answer 1060

L1, L2 testicles move | S3, S4 winks galore

Question 1061

risk of longterm TMP-SMX therapy

Answer 1061

hyperkalemia

Question 1062

global brain ischemia most vulnerable regions

Answer 1062

hippocampus > purkinje cells

Question 1063

Treatment for prolactinoma?

Answer 1063

dopamine agonist cabergoline

Question 1064

Why do Cystic fibrosis pts get so many infections

Answer 1064

mucus cant be cleared allowing for bacterial macrocolonies and protective biofilms

Question 1065

communicating hydrocephalus

Answer 1065

symmetric enlargement of ventricles. due to disruption of arachnoid granulations

Question 1066

where does reactivation TB take place?

Answer 1066

upper lungs

Question 1067

late phase of a type 1 hypersensitivity rxn?

Answer 1067

eosinophil recruitment and release of tissue damaging major basic protein

Question 1068

PCL vs ACL on MRI?

Answer 1068

PCL connects toward side with fibula (small bone) | ACL connects toward side with tibula (big bone)

Question 1069

What abx can decrease metabolism of statins and cause myopathy?

Answer 1069

Macrolides (azithro, clarithro, erythro)

Question 1070

Athletes can have what type of physiologic murmur

Answer 1070

pulmonic flow murmur due to increased stroke volume

Question 1071

muscle that can cause both hip and knee problems

Answer 1071

rectus femoris

Question 1072

NNRTI's

Answer 1072

Do not require phosphorylation to be active. Elephants never delay Efavirenz, nevirapine, delavirdine

Question 1073

During pregnancy what hormone suppresses lactation

Answer 1073

progesterone secreted by the placenta

Question 1074

What is a sign of MILD mitral stenosis

Answer 1074

Loud S1

Question 1075

Why do you get myocyte swelling in transient ischemia?

Answer 1075

ATP pump failure in sarcoplasmic and cell membrane leading to increased intracellular Ca and Na that draws water in

Question 1076

Cystic Fibrosis + hyponatremia?

Answer 1076

Salt wasting in the sweat

Question 1077

obturator nerve

Answer 1077

thigh adduction and medial thigh sensation

Question 1078

hematologic consequences of uricemia ?

Answer 1078

impairs platelet function. Causes prolonged bleeding time

Question 1079

Lower extremity cyanosis and clubbing

Answer 1079

PDA

Question 1080

panic disorder pharmacotherapy

Answer 1080

SSRI

Question 1081

Miosis vs mydriasis

Answer 1081

Miosis- constriction, short ciliary nerve | MyDriasis- Dilation, long ciliary nerve

Question 1082

Topoisomerase drugs mnemonic

Answer 1082

Tucan- Kaitlyn's #1 favorite animal. Topoisomerase 1. Irinotecan, topotecan both sides- poside. Topoisomerase 2. Etoposide, teniposide

Question 1083

ecological study

Answer 1083

uses population level data

Question 1084

acute intermittent porphyria

Answer 1084

wine colored urine, abdominal pain, +/- neuro symptoms PBG/ALA in urine.. Dextrose may help

Question 1085

nerve injured during appendectomy sensation to suprapubic region

Answer 1085

illiohypogastric nerve L1

Question 1086

HAART and fat??

Answer 1086

HAART is associated with body fat redistribution towards more truncal obesity

Question 1087

Glioblastomas staining?

Answer 1087

EGFR

Question 1088

Infective endocarditis and renal issues and presenting signs

Answer 1088

abcess/emboli- flank pain | complex deposition- proteinuria/hematuria.

Question 1089

posterior hip dislocation nerve injury?

Answer 1089

Sciatic nerve

Question 1090

candida skin test

Answer 1090

Used as a cheap way to test for T cell function. Induces a type IV hypersensitivity response where CD4 + T cells, macrophages and later CD8+ T cells respond.

Question 1091

Neuroblastoma

Answer 1091

in children, catecholamines, Homer Wright rossettes. neural crest origin. may cause opsoclonus-myoclonus syndrome. N-myc

Question 1092

Near sighted and far sighted

Answer 1092

myopia- near sighted focuses too far anterior of eye that is too long. Kaitlyn near sighted and very long hyperopia- far sighted. Focuses too far behind retina. eye is too short.

Question 1093

What anti-emetic is good for people with GI infections

Answer 1093

5-HT antagonists

Question 1094

most commonly affected nerve route in cervical spondylosis

Answer 1094

C7

Question 1095

what type of collagen is scar tissue?

Answer 1095

type 1. Granulation tissue is type 3

Question 1096

Types of eukaryote RNA polymerase

Answer 1096

RNA polymerase I: in nucleolus. Makes most of ribosome RNA polymerase II: mRNA, snRNA, Micro RNA RNA polymerase III: TRNA, small component of 60s subunit

Question 1097

Dermatome that goes over the kneecap

Answer 1097

L4

Question 1098

hemodynamically neutral anesthesia induction?

Answer 1098

Etomidate

Question 1099

Central vs peripheral chemoreceptors and breathing

Answer 1099

peripheral (carotid) sense oxygen levels | central (medulla) sense CO2

Question 1100

intermediate acting benzos

Answer 1100

COLA | clonazepam, oxazepam, lorazepam, alprazolam

Question 1101

Difference between HLA 1 and HLA 2?

Answer 1101

HLA 1: aka HLA B27 Present to CD 8+ T cells. Spondylonegative arthropathies HLA 2: DR and DQ alleles. Present to CD 4+ T cells. RA, celiac dz, type I DM

Question 1102

Action sports and sympathometics :)

Answer 1102

Action junkies do EPIc DOPe shit! ^CO/BP Epic cousins (Nor & Pheny) are pressing action sport progression! ^BP -CO Petrol and butane cars are going faster than ever! ^CO Lower BP

Question 1103

Liddle syndrome

Answer 1103

Ameliorate a little HTN. | Collecting duct. Causes HTN via Na resorption. treat with amiloride.

Question 1104

Explain how translation of stop codons works?

Answer 1104

The anticodon of the trinucleotide before the stop codon will be the last to code in a 5-3 direction

Question 1105

mamillary body on MRI

Answer 1105

Bird's beak

Question 1106

RTA's

Answer 1106

Type 2: Proxitwo. loose acid and K in urine Type 1: The distal one. loose K and HCO3 in urine. Ca stones. assoc with calcium stones and AI conditions Type 4: loss of aldosterone. high K assoc with DM and ACE/ARB. TRX fluticortisone

Question 1107

chronic diarrhea or ileostomy and pH

Answer 1107

less bowel HCO3 resorption so constant metabolic acidosis. predisposes to uric acid stones

Question 1108

Osteoporosis vs Primary Hyperparathyroidism

Answer 1108

osteoporosis- trabecular thinning | primary hyperparathyroidism- subperiosteal bone resorption with cortical thinning. High Ca. Possible low phosphate

Question 1109

prostacyclin and platelets

Answer 1109

inhibits platelet binding

Question 1110

Parathyroid blood supply

Answer 1110

inferior thyroid artery a branch of thyrocervical trunk

Question 1111

case series

Answer 1111

pts have disease and there is no control group

Question 1112

What makes up the starry sky in Burkitt lymphoma?

Answer 1112

macrophages and apoptosis of cells

Question 1113

what lymph node would cancer on the tounge metastasize to first?

Answer 1113

submental

Question 1114

Primary adrenal insufficiency weird symptoms

Answer 1114

eosinophilia, anemia, hypoglycemia

Question 1115

What is sorbitol usually converted into?

Answer 1115

Fructose

Question 1116

In MCAD and carnitine deficiency what is the major downstream molecule that can't be formed?

Answer 1116

Acetyl-CoA- which is used for ketone formation and the TCA cycle

Question 1117

Triamterene and amiloride moa?

Answer 1117

Inhibit ENAC sodium channel

Question 1118

Fetal hemoglobin greek letters

Answer 1118

alpha 2 gamma 2

Question 1119

G6PD causes a failure to produce what?

Answer 1119

NADPH , which is also used in FA and cholesterol synthesis

Question 1120

Major cytokine in eosinophil recruitment

Answer 1120

IL-5

Question 1121

What muscle protein is dephosphorylated to cause muscle contraction in both smooth and skeletal muscle

Answer 1121

myosin

Question 1122

Arginase deficiency

Answer 1122

Can't make Urea (CH4N2O) from arginine. Arginine builds up (treatment is to avoid this). spastic diplegia and abnormal movements

Question 1123

what class of HIV drugs can cause metabolic like syndrome

Answer 1123

protease inhibitors

Question 1124

tubocurarine moa?

Answer 1124

competitive ACh antagonist

Question 1125

Cardiac node blood supply

Answer 1125

SA node- RCA | AV node- Depends on dominance

Question 1126

Ehlers Danlos issue in collagen synthesis

Answer 1126

cleavage of N and C terminal ends in extracellular space by procollagen peptidases

Question 1127

ankylosing spodylitis immunogenetic associations

Answer 1127

HLA 1. B 27 and T helper 17 cells + TNF alpha

Question 1128

calculating renal perfusion flow?

Answer 1128

Renal blood flow x (1 - hematocrit)

Question 1129

cholesterol meds that should be avoided in cholecystic dz

Answer 1129

fibrates

Question 1130

Thalamic vs pons vs putamen intracerebral hemorrhage eye findings

Answer 1130

Thalamus- unequal pupils pons- small word pinpoint pupils putamen- dilated pupils

Question 1131

vWF deficiency and ristocetin test

Answer 1131

abnormal (poor plt agglutination)

Question 1132

Strongest to weakest binding of Class 1 antiarrythmics

Answer 1132

Top (strongest) to bottom (Weakest) C.A.B

Question 1133

MecA bacterial gene

Answer 1133

codes for a PBP with low affinity to beta lactam antibiotics.

Question 1134

baroreceptor reflex nerve roots

Answer 1134

afferent- glossopharyngeal | efferent- vagus

Question 1135

MacConkey agar

Answer 1135

turns pink for lactose fermenters

Question 1136

stress hyperglycemia?

Answer 1136

extremely ill/stressed pts will have more gluconeogenesis due to catecholamine increase

Question 1137

What constitutes active RAS in the MAP K pathway?

Answer 1137

RAS is activated when bound to GTP

Question 1138

Nitrates moa

Answer 1138

vasodilation in large veins to reduce preload is the major effect.

Question 1139

Where is vit D3 produced?

Answer 1139

calciTRIol or D3. Tri to make D 3 in the PCT

Question 1140

Pseudo and Pseudopseudo hypoparathyroidism

Answer 1140

Both have Albright hereditary osteodystrophy- Short 4th and 5th digits, short stature, subcutaneous calcification) Pseudo- PTH resistance bc receptor signaling fails pseudopseudo- PTH works fine bc maternal allele rescues signaling

Question 1141

Type 1 DM pathophysiology

Answer 1141

T cell mediated B-islet destruction. May have glutamic acid decarboxylase antibodies that prime T cells

Question 1142

Vaptans

Answer 1142

Block V2 used in SIADH

Question 1143

Anal cancer proximal to dentate lymph mets

Answer 1143

first to internal illiac lymph nodes

Question 1144

Phenoxybenzamine vs phentolamine

Answer 1144

Phenoxybenzamine- irreversible a1 and 2 antagonist | Phentolamine- reversible a1 and 2 antagonist. so it can be overcome by high doses

Question 1145

Consequences of midgut malrotations

Answer 1145

1. obstruction by ladds bands (connect retroperitoneum to colon/cecum) wraps around SMA OR 2. volvulus

Question 1146

zero order kinetics vs first order kinetics

Answer 1146

zero order- constant amount of drug eliminated | First order- constant Fraction of drug eliminated

Question 1147

anaphylactic shock what happens to the vasculature?

Answer 1147

massive vasodilation

Question 1148

Carbon monoxide binding to heme

Answer 1148

competitive. that's why High flow O2 can knock some of it off

Question 1149

Maraviroc vs Enfuvirtide

Answer 1149

Maraviroc- inhibits CCR5 gp120 interaction needed for Macrophage infection (120 is macro than 41) Enfuvirtide- binds gp41 inhibiting entry

Question 1150

Basophilic stippling what is it comprised of?

Answer 1150

ribosomal RNA makes the RBC inclusions. | Happens in Lead poisoning, or sideroblastic anemia

Question 1151

LEAD poisoning mneumonic

Answer 1151

L- lead lines on bones metaphysis E- encephalopathy, erythrocyte stippling A- abdominal pain/anemia D- wrist/ foot drop. Dimercaprol, eDta, succimer

Question 1152

Peripartum cardiomyopathy type?

Answer 1152

Dilated with increased compliance

Question 1153

IL-8

Answer 1153

attracts neutrophils

Question 1154

what hormones inhibits lactation during P despite high prolactin

Answer 1154

progesterone

Question 1155

primary aldosterone's serum Na, Serum K, and HCO3

Answer 1155

Normal Na due to aldosterone escape Serum K low due to excretion HCO3 high due to metabolic alkalosis

Question 1156

What can be used to check for hyperthyroidism during P

Answer 1156

Free T4

Question 1157

Explain pathophys of Sheehan's syndrome

Answer 1157

Pit enlarges during P. But blood supply does not increase proportionally, and with excessive blood loss ischemic necrosis can occur

Question 1158

Other name for Tau

Answer 1158

microtubule associated protein

Question 1159

How is salmonella typhus typically transmitted

Answer 1159

fecal oral, typically contaminated food or water in other countries

Question 1160

Consequence of bad BPH on kidney

Answer 1160

bowmans capsule pressure increases, paranchymal hydrostatic damage, hydronephrosis

Question 1161

What major abdominal organ has dual blood supply?

Answer 1161

Liver. So it is less affected by infarcts from atrial clots. Blood can go into the portal system retrograde from accessory intercostal and phrenic arteriole vessles. In a transplanted liver these accessories are no longer a backup option

Question 1162

Cystinuria

Answer 1162

COLA (Cysteine, ornithine, lysine, arginine) in urine. Risk of SIXtine kidney stones. May be dx by cyanide-nitroprusside test

Question 1163

Differential cyanosis arms vs legs + signs of a PDA

Answer 1163

It is a reverse shunt through the PDA (right to left) usually due to left outflow obstruction or persistent pulmonary hypertension of the newborn

Question 1164

Which HLA's are related to MHC 1 vs 2

Answer 1164

MHC 1- All only have 1 letter (A,B,C) | MHC 2- All have 2 letters (DQ, ect)

Question 1165

Myenteric (Aurbach's plexus)

Answer 1165

In the submucosa. Damage causes dilation via chaga's or Hirsprungs.

Question 1166

Aldosterone's main effects in the serum

Answer 1166

Increases Na Decreases K and CL creates a Metabolic alkalosis H loss and HCO3 gain

Question 1167

Drugs that have zero order elimination (constant amount/time)

Answer 1167

PEA's are shaped like a Zero | Phenytoin, Ethanol, Aspirin

Question 1168

Midodrine

Answer 1168

When your old and in the doldrums you need some midodrine to keep you up (a1 used for postural hypotension)

Question 1169

What Beta blockers help in HF

Answer 1169

B-blockers Curb Mortality | Bisoprolol, carvedilol, metoprolol

Question 1170

excessive internal rotation or quick direction change + hemarthrosis knee injury

Answer 1170

ACL

Question 1171

ABPA signs/symptoms

Answer 1171

Hx of asthma or CF. eosinophilia/ IgE fleeting infiltrates/bronchiectasis positive aspergillus skin test

Question 1172

What type of cell releases renin?

Answer 1172

juxtaglomerular cell of the afferent arteriole which is a modified smooth muscle cell

Question 1173

TB locations

Answer 1173

primary infection: upper portion of lower lobe | reactivation: Upper lobes

Question 1174

Valgus and varus stress and knee injury

Answer 1174

Gus is a guy his legs are together. Us is a girl spreads legs apart valgus- forced stress inward breaks MCL Varus- forced stress outward breaks LCL (less common)

Question 1175

How do you treat Hartnup dz

Answer 1175

High Niacin diet

Question 1176

Supplementation of normal infants

Answer 1176

Vit D, especialy if in north or dark skin Iron after 4months of age until substantial eating of solid foods. Or earlier if preterm Vit K at birth

Question 1177

Atrial Septal Defect murmur

Answer 1177

wide fixed split S2

Question 1178

Histology of late stage radiation dermatitis

Answer 1178

telangiectasia, fibroblast proliferation, homogenization of dermal collagen (mediated by TGF-B)

Question 1179

A fib and cauterization

Answer 1179

recurrent- destroy origin near pulmonary veins | permanent- destroy AV node near the coronary sinus

Question 1180

Fixed dilated pupils what is injured

Answer 1180

midbrain containing the Pretectal and EdingerWestphal nuclei

Question 1181

external hemorrhoid pain mediated by what nerve?

Answer 1181

pudendal

Question 1182

bowel and bladder control nerve and root

Answer 1182

pelvic splanchnic nerve part of cauda equina or tumor met injury S2-S4 relaxes muscles allowing for defecation

Question 1183

Femoral hernia comes out where

Answer 1183

Below inguinal ligament just medial to femoral Vein

Question 1184

Why is elastin so stretchy

Answer 1184

lots of nonpolar AA's and lysine residue crosslinking

Question 1185

What does RT-PCR detect in a sample

Answer 1185

m-RNA

Question 1186

2, 3 bpg and sickle cell

Answer 1186

High levels promote sickling

Question 1187

Enzyme deficiency similar to G6PD

Answer 1187

gluthione reductase

Question 1188

Homocysteinuria nutritional treatment

Answer 1188

Avoid methionine and add B6 (pyridoxine)

Question 1189

Intravaginal block numbs what nerve?

Answer 1189

pudendal

Question 1190

Muscles in sitting up from laying down without hands

Answer 1190

illiopsoas, rectus abdominus and external oblique

Question 1191

abulia

Answer 1191

lack of will usually damage to cingulate gyrus

Question 1192

Ovary, Uterus, Cervix, Vagina, vulva lymph drainage

Answer 1192

``` Ovary- para aortic Uterus- external Iliac Cervix- internal iliac Vagina- proximal to internal iliac; distal to inguinal Vulva- inguinal ```

Question 1193

Hip fracture direction and injury

Answer 1193

``` posterior dislocation- sciatic nerve anterior dislocation (rare)- femoral artery ```

Question 1194

lacunate injury can compress what?

Answer 1194

median nerve similar to carpal tunnel

Question 1195

Niacin is synthesized from what AA?

Answer 1195

tryptophan

Question 1196

How do fibrates cause gallstones?

Answer 1196

Blocking cholesterol 7-hydroxylase

Question 1197

Left upper sternal border vs Upper sternal border

Answer 1197

LUSB- pulmonic murmurs and PDA | LSB- Aortic regurgitation and HCM

Question 1198

What cells release Interferon gamma?

Answer 1198

T cells

Question 1199

What types of malaria have a form that is dormant in the liver

Answer 1199

Vivax and Ovale. These must be treated with primaquine in addition to chloroquine

Question 1200

What anesthesia med may help in bronchospasm?

Answer 1200

Ketamine bc it is a sympathomimetic

Question 1201

What do integrase inhibitors stop

Answer 1201

production of viral MRNA by incorporation into host genome

Question 1202

What pump is important in taking drugs out of CNS that may be inhibited to improve penetration of some drugs like HAART

Answer 1202

P-glycoprotein efflux pump

Question 1203

Histology of a liver infected with Hep B vs Hep C vs Hep A?

Answer 1203

Hep A: Spotty necrosis, ballooning, Counselman bodies Hep B: Ground glass, pale eosinophilic hepatocytes Hep C: lymphoid aggregates and steatotosis

Question 1204

Hardy Weinberg secret/ meaning of equations

Answer 1204

p^2 + q^2 = 1 Refers to Population alleles | p^2 + 2pq + q^2 = 1 Refers to individuals

Question 1205

FBPase-2 and PFK-2

Answer 1205

Fasting: FBPase-2 is activated (more glucagon and cAMP) | Fed state: PFK-2 is activated (more insulin and less cAMP)

Question 1206

Fructose 2,6 bisphosphate

Answer 1206

More F 2,6p gluconeogenesis sinks | activates glycolysis

Question 1207

Urine sodium in hyperaldosteronism and SIADH

Answer 1207

High | Due to aldosterone escape in hyperaldosteronism and downregulated renin in SIADH

Question 1208

50S ribosome inhibitors mnemonic

Answer 1208

The Clorox clean prince Linezolid of the macro 50s ribosome. | Macrolides are azithro, clarithro, erythro

Question 1209

abx class that does not work against anaerobes?

Answer 1209

Aminoglycosides Mean (amino) GNATS cannot kill anaerobes. Bind irreversibly to the 30s ribosome

Question 1210

lactase def stool findings

Answer 1210

low pH

Question 1211

Why are most monoclonal therapies just fragments?

Answer 1211

better tissue penetration

Question 1212

What disorders are REM sleep changes associated with in the elderly?

Answer 1212

alpha-synuclein diseases especially Parkinson's

Question 1213

Contact dermatitis immunology

Answer 1213

sensitization: Langerhans cells Reaction: CD8 cells and Tnf gamma

Question 1214

Frontotemporal dementia molecular issue

Answer 1214

Tau neurofibulary tangles creating Pick bodies | TDP-43 inclusion bodies

Question 1215

pathophysiology of diaper rash

Answer 1215

spares skin folds. | poop urease producing bacteria increase the local skin pH producing irritation

Question 1216

club foot anomaly type

Answer 1216

deformation

Question 1217

TOF murmur and severity

Answer 1217

pulmonic stenosis murmur that gets worse with increased preload causing right blood to go to left circulation without going through the lungs and LA during episodes.

Question 1218

Homocysteinuria what do you supplement

Answer 1218

cysteine