Step Random Tidbits

Question 1

What residues are hydroxylated in the RER during collagen synthesis?

Answer 1

Proline, lysine

Vitamin C is cofactor

Question 2

Function of teres minor

Answer 2

SITS muscle

Adduction, external rotation

Axillary nerve innervation

Question 3

Where do the right and left ovarian vein flow to?

Answer 3

Right ovarian vein feeds into the IVC

Left ovarian vein feeds into the left renal vein

Question 4

Culture negative endocarditis

Organism also causes bacilliary angiomatosis in immunocomprimised

Answer 4

Bartonella Henselae

Question 5

Mutations in transthyretin result in

Answer 5

hereditary cardiac amyloidosis –> infiltrative cardiomyopathy

Question 6

HLA Subtype associates with what disease?

DR4

Answer 6

Rheumatoid arthritis

DM type I (also DR3)

Addison disease (also B8, DR3)

Question 7

DPCC is a major component of:

Answer 7

pulmonary surfactant

Question 8

What do these have in common?

S. pneumoniae

Haemophilus influenzae

Neisseria meningitidis

Salmonella typhi

Group B strep

Answer 8

Encapsulated

risk of infection in SCD post autosplenectomy

Question 9

When does acute rejection occur?

Answer 9

1-4 weeks dense infiltrate of mostly T cells (against foreign MHC)

Question 10

Basket weave pattern of media of large arteries

Answer 10

cystic medial degeneration –> aneurysm Marfan syndrome

Question 11

Embryonic vitelline veins become:

Answer 11

the portal system

Question 12

Damage to optic nerve

Effect on pupillary light reflex

Answer 12

Light in affected eye –> no response in either eye

Light in unaffected eye –> both eyes constrict (motor pathways are intact)

Question 13

HLA Subtype associates with what disease?

DR5

Answer 13

Pernicious anemia

Hashimoto thyroiditis (also DR3)

Question 14

Larger VSDs present with:

Answer 14

Softer murmurs bc the pressure gradient is not there

Question 15

Prior to fertilization, secondary oocytes are arrested in what cell cycle phase?

Answer 15

Metaphase of meiosis II

Question 16

Where is the SA node?

Answer 16

Junction of the SVC and RA

Question 17

What is the difference between binge eating disorder and bulemia?

Answer 17

Binge eating disorder has no compensatory behaviors ie vomiting or fasting or excessive exercise

Bulemia - binges and compensations have to happen at least once a week for 3 months

Question 18

CV complications w/ Down syndrome

Answer 18

Endocardial cushion defects (ie ostium primum ASDs, regurgitant AV valves)

Question 19

Armadillos are a reservoir for:

Answer 19

Mycobacterium leprae

Question 20

Two main anomalies presenting with cyanosis at birth:

Answer 20

Tetralogy of Fallot

Transposition of the great arteries

Question 21

Peaked T waves on EKG indicate

Answer 21

Localized hyperkalemia

First sign of MI

Question 22

How to treat acute dystonia?

Answer 22

Meds w/ M1 receptor antagonism,

ie benztropine, diphenhydramine

restore dopaminergic-cholinergic balance

Question 23

What antibiotic that works by inhibiting protein synthesis can also be used to improve GI motility?

Answer 23

Erythromycin activates motilin receptors

Macrolide binds to 23S of 50S

Question 24

Crescent shaped hematoma on CT

Answer 24

Subdural hematoma

Bridging cortical veins

Between dura and arachnoid

Gradual onset HA and confusion

Question 25

Most common cardiac complications of Marfan syndrome

Answer 25

MVP Cystic medial degeneration of the aorta

Question 26

ST elevation in V1-V4 suggests MI where:

Answer 26

LAD

Question 27

De novo mutations in MECP2 gene associated with

Answer 27

Rett Syndrome MECP2 on X chromosome

Question 28

"Pipestem" fibrosis of portal vein

Answer 28

Hepatic schistosomiasis

Question 29

A single episode of severe vertigo but no hearing loss that can last for days is:

Answer 29

Vestibular neuritis aka labyrinthitis viral or post viral inflammation of the vestibular nerve

Question 30

Pathophys behind Crohn's and gallstones

Answer 30

terminal ileum inflamed --\> bile acids not reabsorbed --\> cholesterol:bile ratio up --\> stones

Question 31

Probe used in Western blot

Answer 31

Antibody

Question 32

Associated cranial nerve and derivative with pharyngeal and aortic arch 2

Answer 32

Facial nerve; Stapedial artery (regresses)

Question 33

Function of IL-4

Answer 33

Secreted by Th2 Induces more differentiation to Th2 Class switching promotion to IgE and IgG

Question 34

Steps in nucleotide excision repair:

Answer 34

Endonuclease nicks both sides of the damage (on 1 strand) DNA polymerase makes new DNA in the place of the damaged DNA DNA ligase seals

Question 35

beta-1 receptor stimulation has what effect?

Answer 35

increase cAMP --\> increase contractility Norepi adrenergic Gs

Question 36

Gene involved in medullary thyroid cancer

Answer 36

RET proto-onco gene codes for tyrosine kinase receptor in both MEN type 2 syndromes and sporadic medullary thyroid cancer

Question 37

Culture Neisseria gonorrhoeae on:

Answer 37

Thayer-Martin VCN medium selective Vancomycin Colistin Nystatin Trimethoprim

Question 38

Hypocapnia leads to what cerebral effect?

Answer 38

Cerebral vasoconstriction pCO2 - potent cerebral vasodilator

Question 39

HLA Subtype associates with what disease? DR2

Answer 39

MS Hay fever SLE Goodpasture syndrome

Question 40

MOA terbinafine

Answer 40

inhibits the synthesis of ergosterol by inhibiting squalene epoxidase tx for dermatophytosis (tinea corporis aka ringworm)

Question 41

Common carotid bifurcates at

Answer 41

C4

Question 42

Aldolase B deficiency

Answer 42

Cant catalyze Fructose-1-P --\>DHAP/Glyceraldehyde failure to thrive, liver and renal failure hypoglycemia and vomiting after fructose ingestion

Question 43

How does the Candida skin test work?

Answer 43

Like PPD Failure to respond - anergy - SCID Macrophages present candida to CD4T's CD4T's recruit CD8Ts via cytokines Induration, erythema CD4 and CD8 release interferon gamma Interferon gamma tells macrophages to eat the Candida

Question 44

Merozoite

Answer 44

Released by liver Infect RBC's Lysis --\> fevers

Question 45

MacConkey's agar and EMB agar are examples of what kind of medium?

Answer 45

Differential identify organism based on metabolic and biochemical properties

Question 46

Give two examples of the effects of hypocalcemia in DiGeorge

Answer 46

Chvostek sign (facial tapping --\> twitchin of nose and lips) Trousseau sign (wrist tapping --\> carpal spasm)

Question 47

Precursor for serotonin, melatonin and nicotinic acid:

Answer 47

Tryptophan (essential)

Question 48

Parasite that causes vitamin B12 deficiency and megaloblastic anemia

Answer 48

Diphyllobothrium latum tapeworm from freshwater fish

Question 49

pH \> 7.45 HCO3 \> 28

Answer 49

Metabolic alkalosis Response: Hypoventilation to retain CO2

Question 50

Central, cystic dilation in cervical spinal cord

Answer 50

Syrinx (C8-T1) damage to vental white commisure and anterior horns syringomelia scoliosis common w/ dx

Question 51

Complete absence of tyrosinase results in

Answer 51

complete albinism production of pigment is defective

Question 52

Recurrent infections with Neisseria suggest

Answer 52

C5b-C9 deficiency cannot form MAC

Question 53

What drug should female epileptic patients switch to of they are considering pregnancy?

Answer 53

Levetiracetam

Question 54

CD31+

Answer 54

CD31 is platelet endothelial cell adhesion molecule indicates vascular endothelial cells liver angiosarcoma (PVC piping/arsenic/thorotrast exposure) expresses CD31

Question 55

Biconvex hematoma on CT

Answer 55

Epidural hematoma Lucid interval Between skull and dura Rupture of middle meningeal artery

Question 56

Pathogenesis of PH from LHF

Answer 56

Passive increase in pulmonary capillary and arterial pressue secondary to pulmonary venous congestion decreased NO increased endothelin (vasoconstrictor) increased vascular tone remodeling/smooth muscle cell proliferation

Question 57

Lower extremity edema Hepatomelagy What kind of HF?

Answer 57

RHF The most common cause of RHF is LHF

Question 58

What antivirals depent only on host cell kinase to work?

Answer 58

Cidofovir, Tenofovir

Question 59

Robertsonian translocations typically involve chromosomes

Answer 59

13, 14, 15, 21, 22 acrocentric chromosomes (centromere at the end) they fuse and lose the short arms balanced translocations go unnoticed

Question 60

Use what medication for gancyclovir-resistant CMV?

Answer 60

Foscarnet AE: hypocalcemia

Question 61

CDKN2A makes

Answer 61

p16 (blocks G1--\>S) TSG melanoma and pancreatic cancer

Question 62

Exaggerated drop in systolic BP during inspiration

Answer 62

Pulsus paradoxus Seen in cardiac tamponade, COPD, asthma, constrictive pericarditis

Question 63

WT-1 - what kind of gene and where?

Answer 63

TSG 11 Wilms tumor

Question 64

Function of serum amyloid A

Answer 64

an acute phase reactant upregulated

Question 65

RB - what kind of gene and where?

Answer 65

TSG 13 Retinoblastoma and osteosarcoma

Question 66

Function of IL-6

Answer 66

secreted by macrophages fever and acute phase proteins

Question 67

Normal A-a gradient

Answer 67

5-15 A-s gradient is normal in alveolar hypoventilation with hypoxemia - how to distinguish from other forms of hypoxemia

Question 68

Immune response involved in Schisto

Answer 68

Th2-mediated granulomatous Th2 cells, eosinophils, M2 macrophages --\> marked fibrosis of bowel or bladder/ureters

Question 69

Elevated ICP in absence of ventricular enlargement

Answer 69

Pseudotumor cerebri young, obese women with HA, papilledema and optic neuropathy

Question 70

First-line tx for Wilson disease

Answer 70

Cu chelators - d-penicillamine - trientine

Question 71

Primary systemic amyloidosis involves deposition of

Answer 71

Immune globulin light chains

Question 72

Function of thyroid peroxidase

Answer 72

oxidation of iodide to iodine, the iodination of thyroglobulin, and iodotyrosine coupling antibodies to thyroid peroxidase in Hashimoto's

Question 73

Steps in collagen synthesis

Answer 73

1. pre-pro-alpha chain 2. signal removed --\> pro-alpha chain 3. hydroxylation of proline and lysine (vit C) 4. glycosylation of hydroxylysine 5. assembly to procollagen 6. to Golgi --\> ECM 7. terminal propeptides cleaved by N and C procollagen peptidases --\> tropocollagen (EDS defect) 8. spontaneous assembly to fibrils 9. cross links by lysyl oxidase

Question 74

Name the 4 beta-lactam classes

Answer 74

1. Penicillins 2. Cephalosporins 3. Carbapenems 4. Monobactams - Aztreonam

Question 75

Labwork with isolated thrombocytopenia suggests what diagnosis?

Answer 75

ITP autoimmune platelet destruction - ecchymoses, petechiae, mucosal bleeding, no other obvious causes of thrombocytopenia

Question 76

What kind of gene is TSC1?

Answer 76

TSG Tuberous sclerosis makes hamartin

Question 77

Acyclovir, Valacyclovir, Famciclovir, Ganciclovir all depend on what to work:

Answer 77

viral kinase class - viral-dependent nucleosides

Question 78

Function of human placental lactoge (hPL) (aka chorionic somatomammotropin)

Answer 78

Decreases maternal fatty acid stores and increases maternal serum glucose in order to provide adequate glucose to the growing fetus (induces insulin resistance in 2nd and 3rd trimesters)

Question 79

Can use Aztreonam in penicillin-allergic patient?

Answer 79

Yes

Question 80

Gamma hemolytic means

Answer 80

No hemolysis on blood agar

Question 81

The difference in risk attributable to the intervention

Answer 81

Absolute risk reduction (ARR) c/(c+d) - a/(a+b)

Question 82

How to confirm a dx of narcolepsy

Answer 82

low CSF levels of hypocretin-1 (orexin-A); shortened REM latency on polysomnography

Question 83

What is the function of C1 esterase inhibitor?

Answer 83

Suppresses activation of the C1 complement component (and therefore the rest of the complement pathway) Also inactivates kallikrein which catalyzes the conversion of kininogen to bradykinin

Question 84

Things that attract neutrophils

Answer 84

LTB4 C5a IL-8 bacterial products

Question 85

Function of pyruvate dehydrogenase

Answer 85

Enzyme in pyruvate --\> Acetyl CoA if nonfunctional, as when inhibited by NADH accumulation, pyruvate becomes lactic acid (anaerobic path)

Question 86

Inhibition of DNA-dependent RNA polymerase MOA of what RIPE therapy component?

Answer 86

Rifampin

Question 87

Innervation of Infraspinatus

Answer 87

SITS muscle Suprascapular nerve C5-C6 External and lateral rotation

Question 88

Histamine upregulates what selectin in rolling?

Answer 88

P selectin (from Weibel-Palade bodies)

Question 89

Absent bilateral vas deferens bilaterally suggests

Answer 89

Cystic fibrosis Normal levels of LH, FSH, testosterone

Question 90

What do trimethoprim, methotrexate and pyrimethamine have in common?

Answer 90

They inhibit the same step in THF synthesis All inhibit dihydrofolate reductase

Question 91

Difference in risk between exposed and unexposed groups; aka the proportion of risk attributable to an exposure

Answer 91

Attributable risk

Question 92

beta-2 receptor stimulation has what effect?

Answer 92

increase cAMP --\> bronchodilation, vasodilation

Question 93

Apocrine glands secrete their product how?

Answer 93

membrane bound vesicles ie mammary glands

Question 94

AR hypersensitivity to UV damage and chemotherapy agents impaired DNA repair facial anomaly growth retardation

Answer 94

Bloom syndrome BLM gene defect makes faulty helicase generalized chromosomal instability --\> risk of neoplasms

Question 95

Teratogenic effects of Aminoglycosides

Answer 95

ototoxicity vestibulotixicity

Question 96

How to increase fetal survival in a preterm fetus with lecthicin:sphingomyelein ratio

Answer 96

Corticosteroids accelerate maturation of type II pneumocytes give to moms at risk of preterm labor

Question 97

RPR positive in what infections?

Answer 97

Syphilis Yaws Pinta Bejel (all subspecies of Treponema pallidum)

Question 98

Embryonic cardinal veins become:

Answer 98

the systemic circulation

Question 99

The third aortic arch becomes

Answer 99

the common carotid artery the proximal internal carotid artery

Question 100

Fever that recurs every 48 hours What malarial organism?

Answer 100

"Tertian" P. vivax P. ovale P. falciparum (more irregular)

Question 101

HLA-B\*57:01 is associated with

Answer 101

Hypersensitivity to Abacavir NRTI Type IV hypersensitivity reaction

Question 102

Immune response involved in tuberculoid leprosy

Answer 102

Th1 Cell mediated immunity (+) lepromin skin test less severe

Question 103

Classical complement pathway means:

Answer 103

C1 binds IgG or IgM bound to antigen (GM makes classic cars) --\> C3 convertase produced

Question 104

At what age? Runs, kicks ball Builds tower of 2-4 cubes Removes clothing 10-25 word vocabulary, identifies 1 or more body parts understands "mine" begins pretend play

Answer 104

18 months

Question 105

A Turner syndrom patient with a bicuspid aortic valve would have what kind of heart murmur?

Answer 105

Early systolic, high frequency click over the 2nd right intercostal space

Question 106

CYP-450 Inhibitors Give 3 examples

Answer 106

Erythromycin grapefruit juice Ketoconazole Ciprofloxacin Quinidine Cimetidine Omeprazole Ritonavir Chloramphenicol Acute alcohol intoxication

Question 107

Translocation in follicular lymphoma

Answer 107

t(14;18) cleaved and noncleaved follicle center cells B cell bcl2 overexpression most common indolent Non-Hodgkin lymphoma

Question 108

What is the function of Rb?

Answer 108

inhibits E2F which blocks G1--\>S

Question 109

Protein involved in AD hereditary hypothalamic DI

Answer 109

Neurophysin II point mutation --\> abnormal folding --\> removal of ADH and neurophysin from the ER

Question 110

Most important AEs of Amphotericin B

Answer 110

Nephrotoxicity Hypokalemia Hypomagnesemia

Question 111

MAO function

Answer 111

Degrades excess monoamine NTs in the presynaptic nerve terminal; Detoxifies tyramine in the GI tract

Question 112

PTSD requires symptoms for how long?

Answer 112

at least 1 month insomnia, nightmares, avoidance, dissociative symptoms, emotional detachment, flashbacks, intrusive thoughts, sleep disturbance

Question 113

Purpose of the dexamethasone suppression test

Answer 113

Will suppress ACTH and cortisol levels with Cushing syndrome if caused by a pituitary adenoma but not when it is caused by ectopic ACTH secretion (ie small cell carcinoma)

Question 114

The probability of being free of disease if the test result is negative

Answer 114

NPV varies with pre-test probability

Question 115

Secreted proteins of innate immunity

Answer 115

Lysozyme Complement C-reactive protein Defensins

Question 116

MOA Finesteride

Answer 116

5-alpha reductase inhibitor decreases testosterone --\> DHT can use for androgenic alopecia early in the course

Question 117

Neuroendocrine cells in the basal layer of the epidermis that are felt to play a role in the perception of touch

Answer 117

Merkel cells often found in association with nerve projections

Question 118

Immune response involved in lepromatous leprosy

Answer 118

Th2 Humoral immunity (-) lepromin skin test bacterial load higher

Question 119

Progressive splenic enlargement and weight loss over months Organism?

Answer 119

Kala-azar aka leishmeniasis (leishmania is a parasite transmitted by sandflies)

Question 120

Most common AE from: Atazanavir, Darunavir, Indinavir, Ritonavir

Answer 120

Hyperglycemia Protease inhibitors Also cause lipodystrophy and drug-drug interactions

Question 121

Otitis externa by a gram negative motile aerobic rod, organism?

Answer 121

Pseudomonas MOE - malignant otitis externa - elderly/diabetic

Question 122

Cavernous lymphangioma Network of endothelium-lined lymph spaces beneath the epidermis Children Neck, Axilla Turner syndrome dx?

Answer 122

Cystic hygroma

Question 123

Contact with infected freshwater Larvae mature in liver Adults got to bladder or intestine Larvae start by living in freshwater snails dx?

Answer 123

Schistosoma Haemobactium --\> bladder Japonicum and Mansoni --\> intestine --\> feces

Question 124

Most cases of cerebellar hemorrhage are caused by

Answer 124

hypertensive vasculopathy

Question 125

HLA Subtype associates with what disease? A3

Answer 125

Hemochromatosis

Question 126

Failure of involution of the mammary ridge causes

Answer 126

accessory nipple aka polythelia, supernumerary nipple; hyperpigmentation epidermal thickening can become tender with hormonal changes

Question 127

What is heteroplasmy?

Answer 127

Different mitochondrial genomes in a singe cell Determines how severe a mitochondrial-encoded disorder can end up being

Question 128

Chronic reduction in CSF absorption at the arachnoid villi --\> massive enlargement of ventricles

Answer 128

Normal pressure hydrocephalus Wet, wacky, wobbly

Question 129

G6PD inheritance

Answer 129

X-linked recessive Males affected, females carriers

Question 130

Teratrogenic effects of TMP-SMX

Answer 130

Neural tube defects

Question 131

An artificial increase in survival time among tested patient who actually have an unchanged prognosis

Answer 131

Lead time bias For example, "new screening test" for poor prognosis diseases ie pancreatic cancer

Question 132

Pathophysiology behind normal pressure hydrocephalus

Answer 132

Progressive decline in absorptive capacity of arachnoid villi Pressure remains normal because gradual distention of ventricules accomodates CSF accumulation periventricular system --\> dementia and emotional blunting; traction of sacral motor fibers --\> urinary incontinence and ataxia; cortical afferent/efferent fibers in corona radiata

Question 133

Mutation involved in anaplastic thyroid cancer

Answer 133

inactivating mutation of p53

Question 134

How do azoles inhibit ergosterol synthesis?

Answer 134

They inhibit the methylation of lanosterol --\> ergosterol

Question 135

Weakness of foot dorsiflexion due to involvement of common peroneal nerve

Answer 135

Charcot-Marie-Tooth disease mutation in myelin protein "neural form" of muscular atrophy

Question 136

The pulmonary trunk is derived from:

Answer 136

the truncus arteriosus

Question 137

Osteogenesis Imperfecta - mutation in what collagen type?

Answer 137

Type I Spontaneous fractures Bone and tooth malformation Blue sclerae due to exposure of choroidal veins

Question 138

IL-4 IL-5 IL-10 IL-13 all secreted by

Answer 138

Th2 cells

Question 139

ST elevation in leads II, III, aVF suggests MI where:

Answer 139

RCA

Question 140

Involuntary movements after chronic use of antipsychotics, ie lip smacking, choreoathetoid movements

Answer 140

Tardive dyskinesia

Question 141

Cushing syndrome with increased ACTH levels - causes?

Answer 141

Pituitary adenoma; ectopic ACTH secretion

Question 142

Ertapenem is unique among the carbapenems because

Answer 142

It does not cover pseudomonas or Acinetobacter

Question 143

Failure of the distal part of the urachus to close results in

Answer 143

Urachal sinus recurrent infection

Question 144

Continued inflammation is mediated by what interleukin?

Answer 144

IL-8, attracts more neutrophils after macrophages come in to clean up the damage

Question 145

Mental status changes Muscle weakness Constipation Polyuria/polydipsia Dehydration Too much of?

Answer 145

Hypercalcemia seen in granulomatous diseases such as sarcoidosis from production of excess 1,25-dihydroxyvitamin D --\> increased intestinal absorption of Ca and phosphate

Question 146

Pulmonary hypolasia Flat facies Limb deformities ie club feet dx?

Answer 146

Potter sequence renal anomaly is bilateral renal agenesis --\> decreased urine output = oligohydramnios

Question 147

Where is IgA made?

Answer 147

Peyer patches

Question 148

AR hypersensitivity to DNA cross-linking agents impaired DNA repair

Answer 148

Fanconi anemia - bone marrow failure (aplastic anemia), short stature, increased incidence of tumors/leukemia, cafe-au-lait spots, thumb/radial defects hypersensitivity of DNA to cross-linking agents

Question 149

Coarse features Corneal clouding Cognitive deficits Failure to thrive Presentation during first year of life dx?

Answer 149

Inclusion cell disease typically fatal in childhood

Question 150

In the bronchioles, what cell secretes mucus?

Answer 150

Club cells | (Goblet cells in bronchi)

Question 151

MOA Aminoglycosides

Answer 151

Bacteriocidal Bind 30S Ineffective against anaerobes Buy AT 30, CCEL at 50

Question 152

Suspensory ligament of the ovary is aka

Answer 152

Infundibulopelvic ligament blood supply to ovary twists in ovarian torsion (cyst or neoplasm are main risk factors)

Question 153

Probe used in Southwestern blot

Answer 153

DS DNA S outhwestern blotting is used to detect DNA-binding proteins such as TFs, nucleases and histones

Question 154

Isoniazid must be processed by:

Answer 154

Mycobacterial catalase peroxidase (to activate drug)

Question 155

Klinefelter syndrome is most commonly caused by:

Answer 155

Meiotic nondisjunction Variants - 46,XY/47,XXY mosaic, 48,XXXY (more severe)

Question 156

Delayed puberty Anosmia Dx?

Answer 156

Kallman syndrome mutation in KAL-1 gene of the FGFR-1 gene failure of GnRH secreting neurons to migrate from their origin in the olfactory placode to the hypothalamus

Question 157

The middle meningeal artery is a branch of:

Answer 157

Maxillary artery (one of the terminal branches of the external carotid artery) Enters skull in foramen spinosum and supplies dura mater and periosteum

Question 158

Dizogotic twins uterus situation:

Answer 158

always dichorionic diamniotic (bc 2 zygotes)

Question 159

What are the cardiovascular complications associated with Turner syndrome?

Answer 159

Aortic coarctation Bicuspid aortic valve

Question 160

ST elevation in leads I and aVL suggests MI where:

Answer 160

Left circumflex (V5, V6 also possible)

Question 161

Teratogenic effect of tetracylcines

Answer 161

staining of teeth, enamel hypoplasia, potential disruption of skeletal development do not use in kids

Question 162

RNA Pol III makes

Answer 162

tRNA 5s rRNA (part of 60S)

Question 163

What's happening in GVHD?

Answer 163

Remaining immunocompetent DONOR T cells become sensitized to HOST MHC. GI issues, rash, diarrhea, liver function abnormalities

Question 164

Codeine Dextromethorphan Fluoxetine Haloperidol Loratadine Metoprolol Paroxetine Risperidone Thioridazine Venlafaxine all metabolized by

Answer 164

CYP 2D6

Question 165

Defect in neutrophil phagosome lysosome function Nystagmus Peripheral and cranial neuropathies Partial albinism

Answer 165

Chediak-Higashi syndrome abnormal giant lysosomal inclusons that are visible on light microscopy of a peripheral blood smear recurrent pyogenic infections (Staph and Strep)

Question 166

Hemolytic anemia in SCD causes what kind of jaundice?

Answer 166

Unconjugated hyperbilirubinemia

Question 167

80% of cardiac myxomas arise in

Answer 167

LA Myxomas produce large amounts of interleukin 6 --\> constitutional symptoms ie fever, weight loss

Question 168

Tyramine - how it works

Answer 168

indirect sympathomimetic usually metabolized by MAO in the gut MAOi - ie phenelzine, tranylcypromine ingest draft beer/aged cheeses/cured meats --\> hypertensive emergency

Question 169

Release of what substance is responsible for red man syndrome?

Answer 169

Histamine AE from vancomycin Prevent by slowing infusion rate

Question 170

The efferent limb of the light reflex pathway is the

Answer 170

PS fibers of the oculomotor nerve

Question 171

Pathologic fractures in children suggest

Answer 171

Extramedullary hematopoiesis Also seen: chipmunk facies from maxillary overgrowth

Question 172

Medullary thyroid cancer is a neuroendocrine tumor that arises from:

Answer 172

parafollicular calcitonin-secreting C cells amyloid from the calcitonin - stain with congo red

Question 173

Hereditary spherocytosis inheritance pattern

Answer 173

AD

Question 174

What is the PPV?

Answer 174

The proportion of people who test + and actually have the disease influenced by prevalence

Question 175

What kinds of medications cause drug-induced Parkinsonism?

Answer 175

Antipsychotics (first gen \> second gen); Antiemetics/gastric motility agents ie prochlorperazine, metoclopramide Both are D2 receptor blockers

Question 176

Function of Ferritin

Answer 176

an acute phase reactant; upregulated; binds and sequesters iron to inhibit microbial scavenging

Question 177

Incomplete division of the forebrain (prosencephalon) into 2 hemisphere is:

Answer 177

Holoprosencephaly "malformation" genetic (trisomy 13, SHH gene mutations), alcohol range: midline cleft palate to cyclops

Question 178

Teratogenic effect of chloramphenicol

Answer 178

gray baby syndrome - gray skin, lethargy, vomiting, cardiopulmonary collapse - can be in infants or in infants whose mothers received med near delivery

Question 179

Histological appearance of Glioblastoma Multiforme

Answer 179

pseudopalisading necrosis - foci of necrosis surrounded by tumor cells, new vessel formation

Question 180

At what age? walks up/down stairs on both feet, jumps builds 6-cube tower copies a line, turns pages 50+ word vocab, 2 word phrases follows 2 step command, parallel play, begins toilet training

Answer 180

2 years

Question 181

MOA Macrolides (ie Erythromycin)

Answer 181

Bind 50S Bacteriostatic Same MOA as Clindamycin and Linezolid

Question 182

Hereditary angioedema involves low serum levels of:

Answer 182

C1 esterase inhibitor AD

Question 183

What kind of gene is TSC2?

Answer 183

TSG Tuberous sclerosis makes tuberin

Question 184

Enfuvirtide prevents

Answer 184

Viral adsorption Fusion inhibitor Binds gp41

Question 185

Segmental thrombosing vasculitis that often extends into contiguous veins and nerves, encasing them in fibrous tissue

Answer 185

Buerger's disease aka thromboangiitis obliterans; can be toxocity or hypersensitivity to tobacco

Question 186

Function of Hepcidin

Answer 186

an acute phase reactant upregulated destroys ferroportin to decrease iron absorption and release (anemia of chronic disease)

Question 187

Ehlers-Danlos - mutation in what collagen type?

Answer 187

Type V

Question 188

Pyrogens like LPS cause macrophages to do what?

Answer 188

IL-1 and TNF, which both upregulate E-selectin on endothelial cells (neutrophil rolling) --\> TNF ups cyclooxygenase activity in the hypothalamus --\> PGE2 also helps, set point for temp raises (fever)

Question 189

Small and shallow, not painful ulcers Large, painful, coalesced inguinal lymph nodes (buboes) Intracytoplasmic inclusion bodies in epithelial cells and leukocytes

Answer 189

Lymphogranuloma venereum Chlamydia trachomatis serotype L1-L3

Question 190

What is the effect of Mullerian Inhibitory factor?

Answer 190

Involution of paramesonephric ducts - to inhibit female reproductive organs Produced by Sertoli cells

Question 191

Inhibition of mycolic acid synthesis MOA of what RIPE therapy component?

Answer 191

Isoniazid

Question 192

Mechanism of resistance acquired by Enterococcus against Aminoglycosides

Answer 192

Enterococcus has developed class-specific modes of resistance Acquired via plasmids or transposons Aminoglycoside-modifying enzymes that transfer chemical groups (ie acetyl groups) to the aminoglycoside molecule and impair their attachement to ribosomal units

Question 193

Never give ACEis to patients with:

Answer 193

hereditary angioedema, bc the increase in bradykinin levels can trigger disease episodes

Question 194

Teratogenic effects of Isotretinoin

Answer 194

Microcephaly Thymic hypoplasia Small ears Hydrocephalus for acne with scarring refractory to other therapy

Question 195

Most common cause of meningitis in babies \> 28 days

Answer 195

S. pneumoniae

Question 196

When receptors aggregate in an allergic response, they attach to what part of IgE?

Answer 196

Fc portion; cross-linking of multiple membrane bound IgE antibodies by a multivalent antigen results in aggregation of the FceRI receptors causing degranulation

Question 197

What is a beta error?

Answer 197

Saying there is no difference between 2 groups when there actually is one (example of a random error)

Question 198

Spasmodic torticollis is what kind of reaction?

Answer 198

Acute dystonic reaction - a type of EPS - likely due to antipsychotic medication between 4 hours and 4 days post new meds Other examples: oculogyric crisis (eyes up) opsthonotonus (arching of back and head thrown back); laryngospasm

Question 199

What is the function of VHL?

Answer 199

TSG; Inhibits hypoxia inducible factor 1a

Question 200

bright red venous blood altered mental status lactic acidosis seizures cardiovascular collapse

Answer 200

cyanide poisoning can be from nitroprusside tx (metabolized to release NO and CN) tx with sulfur donor

Question 201

What pharyngeal and aortic arch completely obliterates in development?

Answer 201

Fifth

Question 202

TPO antibody dx?

Answer 202

Hashimoto

Question 203

Most common cause of Down syndrome.

Answer 203

Maternal meiotic nondisjunction

Question 204

When performing cardiac catheterization, arterial puncture above the inguinal ligament increases the risk of:

Answer 204

Retroperitoneal hemorrhage; Cannot be controlled with manual compression; Most common cause of unexpected mortality after cardiac cath

Question 205

Clozapine

Answer 205

Second generation antipsychotic Third-line for patients refractory to traditional therapy Highest incidence of sialorrhea (drooling)

Question 206

Glial scars are made up of

Answer 206

Astrocytes; \>2 weeks post ischemic stroke

Question 207

Treatment for Wet AMD Wet AMD - acute vision loss (days to weeks), retinal neovascularization metamorphopsia (distortion of straight lines); Subretinal discoloration with adjacent fluid/hemorrhage

Answer 207

VEGF inhibitors ie ranibizumab, bevacizumab and smoking cessation

Question 208

Where in the heart is the most common site for thrombus formation?

Answer 208

Left atrial appendage

Question 209

Most common cardiovascular manifestation associated with SLE

Answer 209

Pericarditis

Question 210

Transamination reactions occur between:

Answer 210

An amino acid and an alpha-keto-acid ; Amino group given to alpha-keto acid to make another aa; Pyridoxal phosphate (vitamin B6) is essential for transaminase action

Question 211

What does MOTEL PASS stand for?

Answer 211

Structures arising from neural crest cells: Melanocytes Odontoblasts Tracheal cartilage Enterochromaffin cells Laryngeal cartilage Parafollicular cells of thyroid Adrenal Medulla and all ganglia Schwann cells Spiral membrane

Question 212

Intellectual disability Gait/posture abnormality Eczema Musty body odor dx?

Answer 212

PKU AR mutation in gene for phenylananine hydroxylase

Question 213

Another word for nucleoside monophosphate

Answer 213

Nucleotide

Question 214

Xeroderma pigmentosum - defect in:

Answer 214

nucleotide excision repair (endonuclease) UV rays --\> thymine dimers but no UV-specific endonuclease to fix AR

Question 215

alpha-1 receptors increase

Answer 215

IP3 --\> peripheral vasoconstriction --\> increase BP, decrease renal and hepatic BF Norepi - adrenergic

Question 216

An arrangement in which a payor pays a fixed (predetermined) fee to cover medical services is called:

Answer 216

Capitation HMOs are structured like this

Question 217

Random presentations of pellagra:

Answer 217

Prolonged isoniazed therapy; Hartnup disease - intestinal and renal absorption of tryptophan is defective; Carcinoid syndrome

Question 218

Proportion of risk reduction attributable to the intervention as compared to a control

Answer 218

Relative Risk Reduction 1-RR

Question 219

Most common site for nosebleeds

Answer 219

Anterior septum Kiesselbach plexus anterior ethmoidal, sphenopalatine and superior labial arteries anatasmose here

Question 220

Teratogenic effects of Valproate

Answer 220

Neural tube defects ie meningomyelocele (decreases levels of folic acid)

Question 221

Teratogenic effect of Warfarin

Answer 221

nasal hypoplasia stippled epiphysis

Question 222

Vitamin K is an essential cofactor for:

Answer 222

gamma-glutamyl carboxlase carboxylates factors II, VII, IX, X

Question 223

Inheritance of Wiskott-Aldrich syndrome

Answer 223

X-linked combined B and T cell disorder

Question 224

Function of Supraspinatus

Answer 224

SITS muscle C5-C6 Suprascapular nerve ABducts arm

Question 225

Most common manifestation of CMV in HIV patients

Answer 225

Retinitis

Question 226

MOA Etoposide

Answer 226

Inhibits eukaryotic topoisomerase II (anticancer) Teniposide same MOA Solid tumors (testicular and SCLC), leukemia, lymphoma

Question 227

Cofactor for glutathione peroxidase

Answer 227

Selenium Used in respiratory burst

Question 228

Amantadine prevents

Answer 228

viral uncoating

Question 229

In hypoglycemia, elevated insulin with undetectable C-peptide suggests:

Answer 229

injection of exogenous insulin (which does not contain C-peptide)

Question 230

What is tachyphylaxis?

Answer 230

negative feedback (decreased production of endogenous NE from the nerve terminals) from overuse of topical nasal decongestants resulting in vasodilation and rebound rhinorrhea examples: phenylephrine, xylometazoline, oxymetazoline = alpha adrenergic agonists NO use can also result in tachyphylaxis

Question 231

Nissl substance

Answer 231

RER of neurons Red neurons = 12-24 hours post acute injury, loss of Nissl substance, pyknosis, eosinophilic, irreversible

Question 232

Head and neck muscle weakness Dysphagia Dysarthria Nuclei of corresponding cranial nerves remain intact

Answer 232

Pseudobulbar palsy Seen in Central pontine myelinolysis = osmotic demyelination of axons in center of pons Bulbar would be a pathologic process in the nerve nuclei

Question 233

Why are dendritic cells, such as Langherhans cells of the skin and mucous membranes, the most effective APCs?

Answer 233

Because they constitutively express MHC II and B7 costimulatory signal Myeloid cell line

Question 234

SCID inheritance

Answer 234

AR or X-linked recessive recurrent severe viral, fungal, opportunistic (ie PJP) infections, chronic diarrhea, failure to thrive tx stem cell transplant

Question 235

Where is fibrocystin found?

Answer 235

epithelial cells of renal tubule and bile ducts

Question 236

Gene involved in follicular thryoid cancer

Answer 236

RAS

Question 237

Most common cause of unilateral fetal hydronephrosis

Answer 237

Obstruction - inadequate canalization of the ureteropelvic junction

Question 238

Function of NF1

Answer 238

TSG; RAS GTPase activating protein aka neurofibromin

Question 239

Acyclovir MOA

Answer 239

Nucleoside analog Activated by viral thymidine kinase Gets incorporated --\> viral DNA synthesis terminated

Question 240

Function of Pyocynanin

Answer 240

Made by Pseudomonas aeruginosa Makes ROS to kill competing microbes

Question 241

vivid dreams, hypersomnia, hyperphagia, acute depression what dx/toxidrome?

Answer 241

cocaine withdrawl

Question 242

Combined UMN/LMN lesions suggest

Answer 242

ALS

Question 243

Associated cranial nerve and derivative with pharyngeal and aortic arch 6

Answer 243

Recurrent laryngeal branch of vagus; Pulmonary arteries, ductus arteriosus

Question 244

Lab finding in Hartnup disease

Answer 244

aminoaciduria (neutrals - alanine, serine, threonine, valine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan, histidine) Treat with high protein diet and niacin

Question 245

Function of Diphtheria toxin

Answer 245

AB exotoxin - inhibits protein synthesis ADP-ribosylation of EF-2

Question 246

How is methicillin (ie nafcillin) resistance conferred?

Answer 246

Alterations in PBPs involved in cell wall synthesis For example, PBP2a has greatly reduced affinity for beta-lactams (except Ceftaroline, 5th gen)

Question 247

Cleavage of the brain structures prosencephalon to telencephalon and diencephalon happens when:

Answer 247

5 weeks

Question 248

Advanced hemochromatosis complication

Answer 248

Diabetes mellitus

Question 249

Neurofibromin ia a key suppressor of what gene?

Answer 249

Ras

Question 250

CV complications with DiGeorge

Answer 250

Tetralogy of Fallot Interrupted aortic arch

Question 251

Relative risk is used in what kind of study?

Answer 251

Cohort study Comparing with exposure to without exposure a/a+b OVER c/c+d

Question 252

Functions of DNA Pol III

Answer 252

5'-3' polymerase 3'-5' exonuclease (most proofreading is in this direction)

Question 253

Why is DNA Polymerase I unique?

Answer 253

Only prokaryotic polymerase that also has 5'-3' exonuclease activity --\> removes RNS primer (made by RNA primase) and repairs damaged DNA sequences Other jobs: 5'-3' polymerase 3'-5' exonuclease

Question 254

Most common viral gastroenteritis in US

Answer 254

Norovirus | (Rotavirus has a vaccine)

Question 255

Region where the frontal, temporal, occipital and sphenoid bones all meet

Answer 255

Pterion damage here - can lacterate middle meningeal artery --\> epidural hematoma

Question 256

Rathkes pouch is invaginated oral ectoderm that becomes:

Answer 256

the anterior pituitary

Question 257

What is the biggest indicator of vertical transmission of Hepatitis B?

Answer 257

HbeAg

Question 258

Patients with hemolytic anemia are predisposed to folic acid deficiency (macrocytic anemia) due to

Answer 258

increased rbc turnover

Question 259

Solution of cardiolipin, cholesterol, lecithin What test?

Answer 259

Rapid plasma reagin (RPR) test Mix patient serum Aggregation = "flocculation" --\> presence of cardiolipin antibodies in serum detects antibodies to human cellular lipids released into the bloodstream after cell destruction by T. palladum.

Question 260

T lymphocytes prevent what kind of fungal infections?

Answer 260

Superficial (oral/esophageal candidiasis)

Question 261

Ataxia telangectasia predisposes to what kind of cancers?

Answer 261

hematologic maligancies ATM gene defect - DNA break repair hypersensitivity to X-ray radiation

Question 262

What is the only embryologic pharyngeal groove that is not obliterated during development?

Answer 262

1st pharyngeal groove Becomes the epithelium of the external ear canal

Question 263

Acute dystonic reactions are thought to result from the antipsychotic property of D2 antagonism in what pathway?

Answer 263

Nigrostriatal pathway Akathisia, Parkinsonism - all D2 blockade causes: haloperidol, fluphenazine

Question 264

What is incised in an episiotomy?

Answer 264

Posterior vaginal opening to Perineal body

Question 265

Testosterone mediated the development of what structures in the male fetus?

Answer 265

Internal genitalia DHT mediates development of external genitalia

Question 266

Azoospermia Eunuchoid habitus Mild intellectual disability Long legs Gynecomastia

Answer 266

Klinefelter syndrome

Question 267

What is the normal function of calcineurin?

Answer 267

Protein phosphatase - activated on stimulation of the appropriate cell receptor in T-cells - dephos NFAT --\> NFAT goes to nucleus to bind IL-2 promoter --\> IL-2 stimulates growth and differentiation of T-cells

Question 268

Nikolsky sign

Answer 268

Sloughing of skin with gentle pressure ie Staph Scalded Skin Syndrome exfoliatin exotoxin

Question 269

Th1 cells secrete

Answer 269

Interferon-gamma \*\*critical for immunity to viral and intracellular bacteria\*\* increases MHC expression activates macrophages promotes Th1 differentation Inhibits Th2 differentiation

Question 270

Pathology in SCID

Answer 270

Defective T cell development and B cell dysfunction --\> loss of both cellular and humoral immunity ADA accounts for 15% of SCID cases

Question 271

Fibrates inhibit the rate-limiting step in bile acid synthesis. What enzyme?

Answer 271

cholesterol 7-alpha-hydroxylase

Question 272

NF-1 - what kind of gene and where?

Answer 272

TSG 17

Question 273

At what age? balances and hops on 1 foot copies a square identifies colors speech 100% intelligible cooperative play

Answer 273

4 years

Question 274

Why are sulfonamides contraindicated in neonates?

Answer 274

Displace bilirubin from albumin --\> kernicterus

Question 275

Associated cranial nerve and derivative with pharyngeal and aortic arch 4

Answer 275

Superior laryngeal branch of vagus; True aortic arch, subclavian arteries

Question 276

Which is the active form of Rb?

Answer 276

Hypophosphorylated Rb is active form --\> prevents G1--\> S

Question 277

Most common cause of coronary sinus dilation

Answer 277

Pulmonary HTN --\> Elevated Right sided heart pressure

Question 278

SCD spleen looks like

Answer 278

Fibrosis, atrophy vasooclusive events --\> infarction

Question 279

What ARE interferons?

Answer 279

Part of innate immunity Made by virally-infected cells and act locally Glycoproteins

Question 280

Third generation cephalosporins have broad spectrum except against

Answer 280

Listeria Listeria has altered PBPs - use ampicillin Facultative intracellular --\> must clear by CMI --\> infants and elderly have bad CMI

Question 281

Parvo is associated with aplastic anemia and what other blood disorder?

Answer 281

Pure Red Cell Aplasia (PRCA) - rare can be viral or autoimmune

Question 282

Sperm use what energy source?

Answer 282

Fructose

Question 283

Hexokinase catalyzes

Answer 283

Fructose --\> F6P

Question 284

Other names for niacin

Answer 284

nicotinic acid vitamin B3 from diet or made endogenously from tryptophan

Question 285

translocation in APL

Answer 285

t(15;17) formation of PML/RARalpha fusion protein results in transcription repression and abnormal receptor that cannot signal for differentiation

Question 286

Function of BRCA1/BRCA2

Answer 286

TSG DNA repair gene Breast and ovarian cancer

Question 287

Fungus have BOTH a cell membrane and a cell wall. What antifungals inhibit cell wall synthesis?

Answer 287

The Echinocandin class Caspofungin and other "fungins" Inhibit beta-glucan synthesis

Question 288

HLA-A, HLA-B, HLA-C code for:

Answer 288

MHC I

Question 289

In hypoglycemia, elevation of both insulin and C-peptide suggests:

Answer 289

excess endogenous insulin due to a sulfonylurea medication or insulinoma

Question 290

Penicillins covalently bind and inhibit

Answer 290

transpeptidase (enzyme for cross-linking)

Question 291

Lab findings in androgenic steroid abuse

Answer 291

Increased Hct

Question 292

APL is associated with what vascular complication?

Answer 292

DIC

Question 293

LMN lesion refers to

Answer 293

damage to the motor neurons of the anterior horn flaccid paralysis, hypotonia, hyporeflexia, atrophy, fasiculations ie poliomyelitis, infantile spinal muscular atrophy

Question 294

Gestational diabetes occurs when

Answer 294

Maternal insulin is inadequate

Question 295

MHC I present what kind of antigens?

Answer 295

Endogenous (viral/cytosolic proteins)

Question 296

Function of IL-12

Answer 296

secreted by macrophages induces differentiation of T cells --\> Th1 cells Activates NK cells

Question 297

Displacement of a malformed tricuspid valve into the RV

Answer 297

Ebstein's anomaly cyanosis and HF from severe tricuspid regurgitation

Question 298

What makes up the MAC?

Answer 298

C5b plus C6-C9

Question 299

HLA Subtype associates with what disease? B27

Answer 299

Ankylosing spondylitis Psoriatic arthritis IBD-associated arthritis Reactive arthritis "seronegative arthropathies"

Question 300

Symptoms of an internal capsule stroke

Answer 300

Pure motor weakness of contralateral lower face, arm, leg

Question 301

C3 convertase function

Answer 301

C3 makes C3a and C3b --\> C3b is an opsonin for phagocytosis C3a mediates mast cell degranulation

Question 302

Necrotic, migratory erythema, anemia and diabetes mellitus suggest what dx?

Answer 302

Glucagonoma markedly elevated glucagon levels

Question 303

What two chemicals are involved in O2-independent killing (not the oxidative burst)?

Answer 303

Lyzozyme Major basic protein

Question 304

Maternal virilization High androgens, low estrogen AR Clitoromegaly/ambiguous genitalia

Answer 304

Aromatase deficiency Female girls have normal internal genitalia Later in life - tall, primary amenorrhea, osteoporosis \*low estrogen delays fusion of the epiphyses\*

Question 305

Fever, tinnitus, tachypnea suggest what dx?

Answer 305

Aspirin intoxication Usually present with a mixed respiratory alklalosis and anion gap metabolic acidosis pH normal bc of competing processes

Question 306

Function of Protein M (strep pyogenes)

Answer 306

Inhibits phagocytosis and complement activation and mediates adherence

Question 307

Where is the optimal site for cardiac cath in the lower extremity?

Answer 307

Below the inguinal ligament Common femoral artery

Question 308

Carrier proteins for oxytocin and vasopressin

Answer 308

Neurophysins - chaperones Oxytocin and vasopressin are made in the paraventricular and supraoptic nuclei, respeictively

Question 309

What organisms does Clarithromycin cover that Erythromycin does not?

Answer 309

Mycobacterium avium (MAC) M. leprae Toxoplasma gondii

Question 310

Caspofungin has the most activity against:

Answer 310

Aspergillus Candida

Question 311

Cortical atrophy in AIDS dementia can result in

Answer 311

Hydrocephalus ex-vacuo \*neuronal volume loss\* ventricles expand but CSF pressure stays normal

Question 312

First viral marker detected in the serum after inoculation with hepatitis B?

Answer 312

HbsAg peaks when patient is most ill drops to undetectable amounts by 3-6 months (if recovery occurs)

Question 313

Most common primary brain tumor in adults

Answer 313

GBM Crosses midline (butterfly appearance)

Question 314

Reactive arthritis often includes what axial involvement?

Answer 314

Sacroilitis

Question 315

Function of TNF-alpha

Answer 315

secreted by macrophages cachexia in malignancy mediates septic shock activates endothelium causes WBC recruitment, vascular leak

Question 316

Cells that express CD3, CD4, CD25 and FOXP3

Answer 316

Regulatory T cells When activated, produce anti-inflammatory cytokines: IL-10, TGF-beta

Question 317

Common mutations associated with hypertrophic cardiomyopathy (AD)

Answer 317

single point missense mutations in genes for: beta-myosin heavy chain myosin-binding protein C

Question 318

Isolated atrial amyloidosis is due to deposition of

Answer 318

abnormally folded atrial natriuretic peptide

Question 319

What is coronary dominance?

Answer 319

The coronary artery that supplies the posterior descending artery (PDA) - PDA supplies the AV node RCA in 70% of people - "right dominant" Left circumflex in 10% of people - "left dominant" Both in 20% of people - "codominant"

Question 320

Function of sulfonylureas

Answer 320

Bind to K-ATP channels and close them (independent of ATP) --\> insulin release This channel is malfunctioning in neonatal diabetes

Question 321

Genetic defect in von Hippel Lindau syndrome

Answer 321

Deletion or mutation of VHL (tumor suppressor gene) on chrom 3p (both sporadic and hereditary RCCC) AD

Question 322

Preformed proteins in cytotoxic T cells

Answer 322

Perforin Granzyme B

Question 323

Sulfonamide antibiotics (ie Sulfamethoxazole) antagonize what compound?

Answer 323

Para aminobenzoic acid (PABA) inhibit dihyropteroic acid synthase Bacteriostatic

Question 324

Source of NADPH

Answer 324

HMP Shunt Used in respiratory burst Reducing equivalent in cytosol

Question 325

MOA Arsenic

Answer 325

inhibition of pyruvate dehydrogenase binds sulfhydryl groups impairs cellular respiration

Question 326

tuncal and gait ataxia, lesion where?

Answer 326

Cerebellar vermis (center line) impaired modulation of the medial-descending motor systems

Question 327

CV complications w/ Marfan syndrome

Answer 327

Cystic medial necrosis (ie aortic dissection, aneurysm); MVP

Question 328

Complete mole genotype

Answer 328

46,XX Paternal DNA only no fetal parts Empty ovum fertilized --\> sperm duplicated to make 46,XX

Question 329

Mutation in Frederich's Ataxia

Answer 329

Frataxin gene - GAA repeat codes for mitochondrial protein important in respiratory function and iron homeostasis

Question 330

What protein does TP53 activate?

Answer 330

P21 which blocks G1--\>S Li Fraumeni syndrome

Question 331

Therapeutic Index

Answer 331

TD50/ED50 or LD50/ED50

Question 332

Criteria for Tourettes

Answer 332

both vocal and motor tics \>1 year onset before 18 tics are irresistible urges followed by feelings of relief

Question 333

The superior vena cava is embryologically derived from:

Answer 333

the common cardinal veins the common cardinal veins drain into the sinus venosus

Question 334

Interferon-gamma release assay

Answer 334

tests latent TB infection better than PPD bc does not cross react with vaccine

Question 335

Every time the GFR halves...

Answer 335

the serum creatinine doubles Relatively large decreases in GFR --\> small increases in serum creatinine (when GFR is normal) Then, small decreases in GFR --\> large changes in creatinine when GFR is low

Question 336

Give what with Imipenem to prevent degradation by renal dihydropeptidases?

Answer 336

Cilastin

Question 337

Squamous cell debris that forms a peraly mass behind the tympanic membrane in the middle ear Dx?

Answer 337

Cholesteatoma cause conductive hearing loss - erosion into auditory ossicles congenital or follow infection/trauma/surgery

Question 338

AR mutation of ATP7B

Answer 338

Wilson disease

Question 339

At what age? Walks up and down stairs alternating feet, rides tricycle copies a circle, uses utensils 3 word sentences, speech 75% intelligible knows age and gender, imaginative play

Answer 339

3 years

Question 340

Abdominal aorta bifurcates at

Answer 340

L4

Question 341

Metanephros forms

Answer 341

the true kidney

Question 342

Short stature Hypotonia Intellectual disability Obesity

Answer 342

Prader-Willi syndrome paternal microdeletion - 15q11-13

Question 343

Main function of IgE

Answer 343

Fixes complement IgG also fixes complement

Question 344

The afferent limb of the light reflex pathway is the

Answer 344

optic nerve

Question 345

Situs inversus Immotile spermatozoa Bronchiectasis, Chronic sinopulmonary infections

Answer 345

Primary ciliary dyskinesia aka Kartagener syndrome Dynein arm defect --\> abnormal ciliary motion

Question 346

Which macrolide is safe for use in pregnancy?

Answer 346

Azithromycin

Question 347

Borders of the femoral triangle

Answer 347

Superior - Inguinal ligament Medial - Adductor longus muscle Lateral - Sartorius muscle

Question 348

What kind of gene id NF2?

Answer 348

TSG Makes merlin (aka schwannomin)

Question 349

Congenital absence of gyri

Answer 349

Lissencephaly severe mental retardation and seizures

Question 350

CV complications with Kartagener syndrome

Answer 350

Situs inversus

Question 351

Cutoffs for ADHD dx

Answer 351

before age 12 at least 6 inattentive and/or hyperactive/impulsive symptoms at least 2 settings

Question 352

Naive B cells express what before differentiation?

Answer 352

IgM and IgD

Question 353

Bcl2- is associated with what translocation?

Answer 353

t(14;18) follicular cell lymphomas Bcl-2 is an apoptosis inhibitor

Question 354

Cause of Menieres disease

Answer 354

Increased pressure and volume of endolymph ear fullness/pain, recurrent vertigo, unilateral \*sensorineural\* hearing loss and tinnitus

Question 355

Vertical transmission of HPV results in:

Answer 355

Respiratory papillomatosis

Question 356

Trachea bifurcates at

Answer 356

T4

Question 357

How do UV rays damage DNA?

Answer 357

Formation of covalent bonds between adjacent thymine/cytosine residues (pyrimidine dimers) Pyrimidine dimers are removed by nucleotide excision repair.

Question 358

Fructokinase catalyzes

Answer 358

Fructose --\> F1P deficient in essential fructosuria benign

Question 359

Function of IL-5

Answer 359

Secreted by Th2 Enhances class switching to IgA Stimulates growth and differentiation of eosinophils

Question 360

Failure of the anterior neuropore to close leads to:

Answer 360

neural tube defects ie anencephaly

Question 361

Color blindness AE of what antibiotic?

Answer 361

Ethambutol RIPE tx Inhibition of RNA synthesis

Question 362

Daptomycin AE

Answer 362

Rhabdomyolysis - elevated creatinine phosphokinase \*\*Daptomycin is inactivated by pulmonary surfactant

Question 363

The mesonephric ducts become:

Answer 363

Epididymus Ductus deferens Seminal vesicles

Question 364

vertigo/nystagmus, lesion where in the cerebellum?

Answer 364

flocculonodular lobe - balance and eye movements dysregulation of the vestibular nucear complex

Question 365

T/F: Deletions are not associated with maternal age

Answer 365

True

Question 366

Zero order drugs:

Answer 366

Aspirin at high concentrations Ethanol Phenytoin

Question 367

Unexplained medical symptoms Excessive health care use dx?

Answer 367

Somatic symptom disorder Tx: Regular visits with same provider, reduce stress, reduce unnecessary workups, assure patient serious stuff is ruled out - goal is functional improvement

Question 368

Demecloycline use

Answer 368

Tetracycline used for SIADH

Question 369

Teratogenic effects of Lithium

Answer 369

Ebstein anomaly Nephrogenic diabetes insipidus Hypothyroidism

Question 370

What is PCV13?

Answer 370

13-valent pneumococcal conjugate vaccine nontoxic diphtheria protein conj to polysacchardies T-cell recruitment --\> memory B cells --\> higher and longer lasting immunity Use PPSV23 for \>65 or diabetic, COPD, CVD (polysaccharide only)

Question 371

Beta-2-glycoprotein-I antibody suggests what diagnosis?

Answer 371

SLE Antiphospholipid antibodies --\> paradoxical hypercoagulable state with prolonged aPTT

Question 372

Lateral hemisphere of the cerebellum controls

Answer 372

Motor planning

Question 373

Persistent lymphedema following a radical mastectomy predisposes to

Answer 373

lymphangiosarcoma

Question 374

Causes of reactive arthritis:

Answer 374

Chlamydia Salmonella Shigella Yersinia Campylobacter C. diff

Question 375

HLA Subtype associates with what disease? B8

Answer 375

Addison disease Myasthenia Gravis

Question 376

Function of IL-1

Answer 376

secreted by macrophages aka osteoclast activating factor causes fever and acute inflammation activates endothelium to express adhesion molecules induces chemokine secretion to recruit WBCs

Question 377

The acute onset of mental status change is most suggestive of:

Answer 377

delirium acute, reversible, fluctuating LOC

Question 378

C-reactive protein function

Answer 378

Opsonin; fixes complement; facilitates phagocytosis ; an acute phase reactant, upregulated - measured clinically as an ongoing sign of inflammation

Question 379

Teratogenic effect of Methotrexate

Answer 379

Limb and cranial abnormalities Neural tube defects Abortion

Question 380

What happens when a partial agonist is added in the presence of a full agonist?

Answer 380

The response of the full agonist is reduced The partial agonist acts as an antagonist

Question 381

MEN1 makes

Answer 381

Menin TSG 3P's for MEN1 (pancreatic, primary hyperparathyroidism, pituitary)

Question 382

Hagemen Factor (Factor XII) is activated by

Answer 382

collagen

Question 383

Helper T cells differentiate into

Answer 383

IL-12 make Th1 IL-4 make Th2 TGF-beta and IL-6 make Th17 all in the lymph node

Question 384

Why do patients with TB or sarcoidosis have hypercalcemia?

Answer 384

PTH-independent conversion expression of 1-alpha-hydroxylase in activated macrophages 1-alpha hydroxylase turns 25-D to 1,25 D (normally in the kidney) can also see the same thing in Hodgkin disease and some non-Hodgkin lymphoma

Question 385

How is pre-mRNA processed?

Answer 385

Processed in the nucleus, Add 5' cap (methylguanosine) Add poly A tail Splice (GU at 5' and AG at 3') by spliceosomes

Question 386

Function of C5 convertase

Answer 386

C5 --\> C5a and C5b C5b to MAC C5a is chemotactic for neutrophils

Question 387

Uterine arteries are branches of

Answer 387

internal iliac artery

Question 388

Serum screening results in Down Syndrome

Answer 388

Low AFP Low unconjugated estriol High inhibin A High b-hCG

Question 389

Holocrine glands secrete their product how?

Answer 389

Cell lysis sebaceous glands meibomian (eyelid) glands

Question 390

The nucleus basalis of Meynert houses the cell bodies of:

Answer 390

cholinergic neurons In Alzheimer's, these neurons secrete decreased amounts of acetylcholine.

Question 391

Endonuclease that degrades all RNA in the cell Activated by dsRNA

Answer 391

RNaseL (Ribonuclease L) an interferon

Question 392

Give the equation for NNT

Answer 392

1/ARR = 1 OVER c/[(c+d) - a(a+b)] switch the terms for NNH

Question 393

Function of Myeloperoxidase

Answer 393

Found in neutrophils Converts H2O2 --\> HClO (hypochlorous acid)

Question 394

On ECG, prominent Q waves suggest

Answer 394

An old MI

Question 395

Enzyme involved in collagen cross-linking

Answer 395

Lysyl oxidase (Menke's disease - Cu deficiency - corkscrew hair)

Question 396

A vaccine with a polysaccharide capsule induces what immune response?

Answer 396

B cell only Need a protein conjugate for B and T cell response and longer immunity (through production of memory B cells)

Question 397

Why does ventilation INCREASE from apex to base during inspiration?

Answer 397

Because alveoli expand more at the lung base (during inspiration) At end-expiration, apex alveoli are more stretched

Question 398

Paroxysmal nocturnal dyspnea Orthopnea Dyspnea on exertion What kind of HF?

Answer 398

LHF

Question 399

The ductus arteriosus is an embryonic derivative of:

Answer 399

the sixth aortic arch

Question 400

What kind of cancer does PTEN cause?

Answer 400

TSG breast/prostate/endometrial

Question 401

Phrenic nerve innervated what pleura

Answer 401

mediastinal and diaphargmatic pleura (C3-C5) --\> sharp pain at base of neck

Question 402

CV complications with Friederich ataxia

Answer 402

Hypertrophic cardiomyopathy

Question 403

0.7Vd/Cl

Answer 403

Half life

Question 404

Abnormally upslanting left atrial "v wave" during cardiac catheterization

Answer 404

Mitral regurgitation

Question 405

Chemically modified bases such as pseudouridine, dihydrouridine, ribothymidine, are found where?

Answer 405

tRNA small, noncoding RNA CCA sequence at 3' end used as recognition sequence by proteins - the aa binding site is the 3' terminal OH

Question 406

Clavulanate Sulbactam Tazobactam are?

Answer 406

beta-lactamase inhibitors use with penicillins

Question 407

Bilaterally enlarged, cystic fetal kidneys on US; Oligohydramnios dx?

Answer 407

AR Polycystic kidney disease (ARPKD) Defect in PKHD1 - makes fibrocystin

Question 408

The ureteric bud gives rise to:

Answer 408

the collecting system of the kidney = pelvis, collecting ducts, calyces and ureter

Question 409

What paraneoplastic condition is associated with squamous cell lung carcinoma?

Answer 409

PTPrP and hypercalcemia

Question 410

HNPCC occurs due to a defect in:

Answer 410

DNA mismatch repair enzymes

Question 411

Chi-square tests

Answer 411

The relationship between two categorical variables (ie therapy vs no therapy)

Question 412

RNA Pol I functions exclusively to transcribe

Answer 412

45S pre-rRNA that eventually becomes 18S, 5.8S, 28S rRNA

Question 413

HLA Subtype associates with what disease? DQ2/DQ8

Answer 413

Celiac disease "I 8 2 much gluten at Dairy Queen"

Question 414

Drugs that inhibit calcineurin activation

Answer 414

Cyclosporine Tacrolimus Immunosuppressants

Question 415

Associated cranial nerve and derivative with pharyngeal and aortic arch 3.

Answer 415

Glossopharyngeal (IX); Common carotid, Proximal ICA

Question 416

In the CNS, serotonergic neurons are located:

Answer 416

in the raphe nuclei of the brainstem (midbrain, paons, medulla) axons project widely into cerebral cortex -- thalamus, hypothalamus, cerebellum, hippocampus, spinal cord

Question 417

Teratogenic effect of ACE inhibitors

Answer 417

Renal dysgenesis Oligohydramnios

Question 418

Prokaryotic topoisomerase II (DNA gyrase) is inhibited by:

Answer 418

Fluroquinolones (ie Ciprofloxacin)

Question 419

Ethanol Isoniazid Acetominophen (at high doeses) all metabolized by

Answer 419

CYP 2E1

Question 420

CYP-450 Inducers Give 3 examples

Answer 420

Phenobarbital Nicotine St. John's Wort Rifampin Phenytoin Carbamazepine Chronic alcohol consumption

Question 421

Genetic defect in Prader Willi syndrome

Answer 421

15q deletion

Question 422

RNA Pol II makes

Answer 422

mRNA snRNA micro RNA

Question 423

Prolactin-secreting adenomas cause:

Answer 423

Galactorrhea and hypogonadism in men Amenorrhea in women

Question 424

Pain and temperature is transmitted by the

Answer 424

spinothalamic tract

Question 425

Alprazolam Carbamazepine Cyclosporine Diltiazem Erythromycin Azoles Lidocaine Lovastatin Midazolam Nifedipine Quinidine Simvastatin Tacrolimus Verapimil all metabolized by

Answer 425

CYP 3A4 50-60% of all drugs metabolized by 3A4

Question 426

Blowing holosystolic murmur at cardiac apex, radiation to axilla

Answer 426

Mitral regurgitation Rheumatic fever (Mitral stenosis is a snap as opposed to a murmur)

Question 427

Narcolepsy with cataplexy is most often caused by the lack to 2 related neuropeptides, hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B), located:

Answer 427

in the lateral hypothalamus

Question 428

At age 2, a child should have a vocabulary of:

Answer 428

50-200 words, 2 word phrases language is the most commonly delayed milestone always get a hearing examination

Question 429

HPV has predilection for what kind of epithelium?

Answer 429

Stratified squamous | (ie true vocal cords, cervix, anus)

Question 430

The metanephric mesoderm (blastema) gives rise to:

Answer 430

Renal cortex stuff: glomeruli Bowman's space PCT DCT loop of Henle

Question 431

MHC II present what kind of antigens?

Answer 431

Exogenous (ie bacterial)

Question 432

Hb-NH-CO2

Answer 432

Carbamate How Hb carries CO2 back to lungs 15% of CO2 travels this way, the rest as bicarb

Question 433

Glucagon is released by what pancreatic cells?

Answer 433

Alpha cells of the islets of Langerhans

Question 434

Handgrip maneuver Effect on heart

Answer 434

Increases afterload Can detect VSD bc blood Left--\> right Can hear holosystolic murmur

Question 435

Enzyme involved in CO2 + H2O --\> H2CO3

Answer 435

Carbonic anhydrase H2CO3 --\> H + HCO3- HCO3- diffuses out and Cl- diffuses in (maintains electronic gradient) = "chloride shift"

Question 436

Failure of the central portion of the urachus results in

Answer 436

urachal cyst

Question 437

Multiple deep ulcers with gray/yellow exudate at base Organisms clump in long parallel strands to create a "school of fish" appearance Ulcers are painful

Answer 437

Chancroid Haemophilus ducreyi

Question 438

pH \> 7.45 PaCO2 low

Answer 438

Respiratory alkalosis Response: delayed, to lower HCO3

Question 439

Most common mutation in CF results in

Answer 439

deletion of the three nucleotides that code for phenylalanine at aa 508 delta-F508, 70% of cases CFTR is an integral membrane protein

Question 440

Penicillins are synergistic with what other drug class in tx of enterococcus/pseudomonas?

Answer 440

Aminoglycosides (Gentamicin) Aminoglycosides are polar - cannot cross cell wall Penicillinc weaken cell wall --\> penetration of Aminoglycosides

Question 441

Charcot-Bouchard aneurysms can rupture and cause:

Answer 441

intracerebral hemorrhage (NOT SAH) CB aneurysms - small - longstanding HTN found in arterioles that supply the basal ganglia, internal capsule, deep white matter

Question 442

What acute phase reactants are downregulated in inflammation?

Answer 442

albumin - reduction conserves aa's for positive reactants Transferrin

Question 443

Most common cause of bilateral fetal hydronephrosis in boys

Answer 443

Posterior urethral valves

Question 444

Neuromuscular lesions Ragged skeletal muscle fibers lactic acidosis what dx?

Answer 444

Mitochondrial encephalomyopathy

Question 445

At what age? Stands Walks first steps independently Throws ball 2 finger pincer grasp Says first words besides mama and dada Separation anxiety Follows 1-step commands

Answer 445

12 months

Question 446

Toddler with painless GI bleeding due to ectopic gastric mucosa

Answer 446

Meckel diverticulum Failure of obliteration of the vitelline (or omphalomesenteric) duct

Question 447

Finding in Mayer-Rokitansky-Kuster-Hauster syndrome

Answer 447

aka Mullerian aplasia no upper vagina variable uterine development --\> primary amenorrhea Ovaries OK --\> secondary sex characteristics OK

Question 448

What is the preferred treatment for Enterobius Vermicularis in pregnant patients?

Answer 448

Pyrantel Pamoate | (Albendazole for everyone else)

Question 449

What posttranslational modification signals proteins for lysosomes?

Answer 449

Phosphorylation of mannose residues by phosphotransferase enzyme defective in Inclusion cell (I-cell) disease

Question 450

Nissl substance becomes fine, granular and dispersed throughout the cytoplasm of a neuron; Within 24-48 hours of injury

Answer 450

Axon has been severed --\> Nissl is trying to regenerate proteins "Axonal reaction" - cell will be enlarged and rounded

Question 451

Posterior surface of the heart is formed mainly by:

Answer 451

Left atrium

Question 452

The Haemophilus influenzae serotype b vaccine is made of:

Answer 452

Capsular polysaccharide conjugated to a carrier protein (TTP from tetanus or OMP from Neisseria)

Question 453

HLA Subtype associates with what disease? DR3

Answer 453

DM type I SLE (also DR2) Graves disease Hashimoto thyroiditis (also DR5) Addison disease (also B8, DR4)

Question 454

In Roseola (HHV6), when does the rash appear?

Answer 454

When the fever subsides

Question 455

Binds ergosterol on cell membranes Some activity against cholesterol --\> AEs like nephrotoxicity

Answer 455

MOA of Amphotericin B

Question 456

UMN lesion refers to

Answer 456

any damage above the anterior horn is stroke, brain tumor spastic paralysis, clasp-knife rigidity, hyperreflexia, Babinski sign \*Lesions to the corticospinal tract do not cause sensory deficits

Question 457

IL-10 decreases expression of:

Answer 457

MHC II and Th1

Question 458

Case control studies use what statistical comparison?

Answer 458

Odds ratio With disease vs without disease ad/bc

Question 459

Merocrine glands secrete their product how?

Answer 459

Exocytosis ie salivary, eccrine sweat glands, apocrine sweat glands

Question 460

RNA Pol I makes

Answer 460

rRNA

Question 461

Diazepam Omeprazole all metabolized by

Answer 461

CYP 2C19

Question 462

Bitemporal hemianopsia from mass effect suggests what kind of tumor?

Answer 462

Pituitary adenoma - prolactinomas are the most common

Question 463

DPC4/SMAD4 gene products are deleted in

Answer 463

pancreatic cancer TSG

Question 464

Associated cranial nerve and derivative with Pharyngeal and aortic arch 1

Answer 464

Trigeminal; Maxillary artery portion

Question 465

Tryptase is an enzyme specific for:

Answer 465

mast cells anaphylaxis

Question 466

Innervation of Subscapularis muscle

Answer 466

Upper and Lower subscapularis nerve Interna/medial rotation, Adduction C5-C6 SITS

Question 467

Glucose enters beta cells through what transporter?

Answer 467

GLUT-2 glucose --\> TCA --\> increase in ATP --\> ATP binds an closes K-ATP channel --\> ATP rises in cell --\> Ca channels open --\> that and increase in cAMP from GLP-1 transporter effects together lead to insulin exocytosis

Question 468

Caffeine Ciprofloxacin Theophylline R-warfarin all metabolized by

Answer 468

CYP 1A2

Question 469

Most common mutation in Polycythemia Vera

Answer 469

V617F mutation in JAK2 gene #617 valine --\> phenylalanine hematopoietic cells more sensitive to growth factors ie EPO and thrombopoietin

Question 470

CV complications w/ Tuberous Sclerosis

Answer 470

Cardiac rhabdomyomas --\> valvular obstruction

Question 471

A patent urachus connects

Answer 471

The umbilicus to the bladder (Persistance of allantois remnant) Allantois becomes urachus Pee through belly button

Question 472

Function of IL-8

Answer 472

secreted by macrophages major chemotactic factor for neutrophils

Question 473

The 3rd pharyngeal pouch becomes

Answer 473

The inferior PTH glands Thymus

Question 474

Treatment for Tourettes

Answer 474

Antipsychotics Alpha-adrenergic receptor agonists Behavioral therapy

Question 475

Garlic breath vomiting QT prolongation watery diarrhea

Answer 475

Arsenic poisoning Tx dimercaprol (British anti-Lewisite) or DMSA (succimer)

Question 476

Why are fluoriquinolones contraindicated in children?

Answer 476

Cartilage development impaired --\> tendonitis and rupture

Question 477

Superoxide dismutase Glutathione peroxidase Catalase all have what in common?

Answer 477

Antioxidant enzymes ROS --\> Oxygen and water

Question 478

Bloon in basal cisterns on CT

Answer 478

Subarachnoid hematoma Worst HA of my life, fever, nuchal rigidity Between arachnoid and pia mater Aneurysm or AV malformation of anterior and posterior communicating arteries

Question 479

Genetic defect in cri-du-chat syndrome

Answer 479

5p deletion

Question 480

Ibuprofen Naproxen Phenytoin S-warfarin all metabolized by

Answer 480

CYP 2C9

Question 481

Vibration and proprioception is transmitted by:

Answer 481

Dorsal column pathway

Question 482

Cerebella hemangioblastomas, clear cell renal carincomas, pheochromocytomas - what condition?

Answer 482

von Hippel Lindau

Question 483

Immune response to killed vaccine

Answer 483

Humoral only Live attenuated is cellular and humoral

Question 484

Valacyclovir is a prodrug for

Answer 484

Acyclovir

Question 485

Teratogenic effect of Phenytoin

Answer 485

Neural tube defects Orofacial clefts Microcephaly Nail or digit hypoplasia

Question 486

MOA Fluoroquinolones

Answer 486

Inhibit two DNA gyrases (bacterial DNA top II and IV) ie Cipro, all "floxacins"

Question 487

Germline mutations in the RET proto-oncogene include:

Answer 487

Pheochromocytoma; Medullary thyroid cancer (parafollicular C cell malignancy); Parathyroif hyperplasia (MEN2A) of mucosal neuromas and marfanoid habitus (MEN2B) Multiple endocrine neoplasia type 2

Question 488

Benztropine and Trihexyphenidyl are

Answer 488

Anticholinergics use in treatment of drug-induced Parkinsonism

Question 489

High altitude results in hypoxemia with respiratory:

Answer 489

alkalosis CO2 low (hyperventilation) --\> bicarb lowers within 48 hours via renal excretion of bicarb

Question 490

The most abundant aa in collagen

Answer 490

Glycine Gly-X-Y (every 3rd aa) Collagen is 3 alpha chains held together by hydrogen bonds

Question 491

The most important mediator for sepsis

Answer 491

TNF-alpha acute phase cytokine produced by activated macrophages.

Question 492

Increased 2,3 DPG Effect on Hb curve

Answer 492

Right shift (also increased temp, decreased pH)

Question 493

D-ala-D-lactate

Answer 493

vancomycin resistant bacteria

Question 494

MOA Zidovudine

Answer 494

aka AZT NRTI competitively binds to reverse transcriptase, incorporated into viral genome as a thymidine analog \*\*No 3'OH group --\> 3'-5' phosphodiester bond formation

Question 495

c-MYC located on chrom:

Answer 495

8 - Burkitt lymphoma and diffuse large B cell lymphoma

Question 496

Subjective restlessness with inability to sit still - EPS

Answer 496

Akathisia

Question 497

Craniopharyngiomas arise from

Answer 497

remnants of Rathke's pouch

Question 498

Probe used in Southern or Northern blot

Answer 498

ssDNA or RNA (hybridization probe)

Question 499

How to diagnose trich

Answer 499

wet mount aka saline microscopy

Question 500

alpha-2 receptors have what effect?

Answer 500

decrease cAMP --\> decrease release of norepi and insulin Norepi Adrenergic

Question 501

Subacute bacterial endocarditis with strep gallolyticus (bovis) suggests

Answer 501

colon cancer

Question 502

Melanocytes arise from what germ layer?

Answer 502

Neural crest cells Malignancy of melanocytes = melanoma

Question 503

MOA trimethoprim

Answer 503

inhibits dihydrofolate reductase

Question 504

MHC-II is encoded by

Answer 504

HLA-DP HLA-DQ HLA-DR

Question 505

Extensive and progressive ulcerative lesions w/o lymphadenopathy Base may have granulation tissue Deeply staining gram-negative intracytoplasmic cysts called Donovan bodies Ulcers not painful

Answer 505

Granuloma inguinale Klebsiella granulomatis

Question 506

AE Linezolid

Answer 506

High risk for serotonin syndrome Thrombocytopenia Optic neuritis

Question 507

Zidovudine - analog of:

Answer 507

thymidine competiviely binds to RT incorporated into viral genome azido group in place of 3'OH --\> chain termination

Question 508

Protease inhibitor SE

Answer 508

hyperglycemia lipodystrophy dislipidemia insulin resistance cyp 450 inhibition

Question 509

InteGRAse inhibitors

Answer 509

Dolutegravir Raltegravir

Question 510

Griseofulvin interacts with

Answer 510

fungal cell MTs tx for dermatophytes

Question 511

NK cells express either

Answer 511

CD16 or CD56 \*present in athymic patients bc they do not require the thymus to mature

Question 512

NK cells are activated by

Answer 512

interferon-gamma and IL-12

Question 513

AR deficiency of apolipoprotein B48 and B100 Malabsorption

Answer 513

Abetalipoproteinemia

Question 514

sulfa drug that is also a carbonic anhydrase inhibitor

Answer 514

Acetozolamide SE metabolic acidosis, hypokalemia can reduce ICP in idiopathic intracranial HTN

Question 515

Tx for Acetominophen OD, replenishes glutathione

Answer 515

Acetylcysteine

Question 516

Stewart-Treves syndrome, risk factor

Answer 516

Lymphedema, ie as precipitated by radical mastectomy Angiosarcoma

Question 517

Bullous pemphigoid IgG distribution

Answer 517

Linear at BM Pemphigus vulgaris is netlike IgG distribution

Question 518

Most common malignancy associated with acanthosis nigracans

Answer 518

Gastric adenocarcinoma

Question 519

d-aminolevulenic acid in the urine child with constipation, anemia, cognitive problems

Answer 519

lead poisoning

Question 520

bilious vomiting abdominal distention inability to pass meconium

Answer 520

Hirschsprung disease seen in newborn failure of internal sphincter relaxation megacolon

Question 521

linear xanthoma - linear lesion on skin fold strongly associate with

Answer 521

primary biliary cirrhosis

Question 522

When strawberry (capillary) hemangiomas are found viscerally what organ is commonly involved?

Answer 522

Liver

Question 523

Complications of psoriasis

Answer 523

Conjunctivitis, blepharitis, uveitis; yellow-brown discoloration of nails with pitting or crumbling; arthritis

Question 524

BRAF mutation V600E (meaning valine --\> glutamine at protein 600) what cancer?

Answer 524

Melanoma mutation seen in 40-60% of patients

Question 525

Vemurafenib

Answer 525

potent BRAF inhibitor BRAF is a protein kinase Vemurafenib is menaloma tx

Question 526

Acantholysis

Answer 526

loss of intracellular connections ie VZV, PV

Question 527

Subepidermal blister with neutrophils in dermal papilla

Answer 527

dermatitis herpeteformis

Question 528

most common benign vascular tumor in adults

Answer 528

cherry hemangiomas aka senile hemangiomas \*always superficial (vs strawberry hemangiomas in babies)

Question 529

Sulfonamides Phenytoin Allopurinol All known for what AE?

Answer 529

SJS - fever, hypotension and skin slouging

Question 530

Erythema multiforme - target lesions - commonly associated with

Answer 530

recent infection ie herpes simplex, mycoplasma can also be seen with sulfonamide use, malignancy etc.

Question 531

Elevated what seen in porphyria cutanea tarda?

Answer 531

urinary porphyrin levels - uroporphyrin, heptacarboxyl porphyrin skin fragility and blistering lesions in sun exposed areas

Question 532

Benign proliferations of melanocytes that involve both the dermis and the epidermis

Answer 532

Compound nevus

Question 533

accumulation of edema fluid in the intercellular spaces of the epidermis

Answer 533

spongiosis seen in acute allergic contact dermatitis - a kind of eczema type IV hypersensitivity reaction

Question 534

Ipratropium, class and effect

Answer 534

Anticholinergic blocks ACh at muscarinic receptors prevents bronchoconstriction and reduced PS stimulation to tracheobronchial submucosal glands in the lungs

Question 535

Clindamycin, activity against

Answer 535

Gram pos and anaerobes good for aspiration pneumonia and abscess binds to 50S

Question 536

Zolpidem

Answer 536

non-benzodiazepine hypnotic used for insomnia

Question 537

COMT inhibitors are used for

Answer 537

Entacapone, Tolcapone Catechol-O-methyl transferase (COMT) - brain and liver - degrades catecholamines COMT inhibitors prolong the effects of levodopa in Parkinson disease tx

Question 538

Cocaine

Answer 538

Indirect sympathomimetic Blocks reuptake of dopamine, norepi and serotonin in presynaptic cleft

Question 539

Isoniazid is matabolized by

Answer 539

Acetylation Fast and slow acetylators Other drugs metabolized like this: dapsone, hydralizine, procainamide

Question 540

Major Clozapine AE

Answer 540

Agranylocytosis, must monitor absolute neutrophil count For refractory schizophrenia w/ suicidality Low EPS risk

Question 541

Chlordiazepoxide

Answer 541

Long acting benzo Tx of EtOH withdrawl

Question 542

Benzodiazepines without active metabolites are preferred for use in patients with liver disease. These include:

Answer 542

Lorazepam Oxazepam Temazepam

Question 543

MOA Benzodiazepines

Answer 543

Bind allostericall to GABA channel Increases Cl- through channel

Question 544

High potency antipsychotics SE

Answer 544

EPS ie Fluphenazine, Haloperidol

Question 545

Low potency antipsychotics SE

Answer 545

Anticholinergic effects, sedating, orthostatic hypotension ie Chlorpromazine

Question 546

Venlafaxine

Answer 546

SNRI

Question 547

Imipramine

Answer 547

TCA

Question 548

Inactivating mutations involving the pro-apoptotic BMPR2 gene

Answer 548

Primary pulmonary HTN Women 20-40 Endothelial and smooth cell proliferation --\> vascular remodeling, elevated pulmonary vascular resistance, progressive pulmonary HTN Lung transplant is only tx, but Bosentan can promote vasodilation and relieve symptoms

Question 549

Bosentan MOA

Answer 549

Endothelin-receptor antagonist (competitive) Vasodilator (bc endothelin is a vasoconstrictor) Decreases pulmonary arterial pressure and lessens progression of vascular and right ventricular hypertrophy

Question 550

Risperidone primary MOA

Answer 550

D1 and D2 receptor antagonist Antipsychotic Hyperprolactinemia and amenorrhea (inhibition of GnRH release) possible SE

Question 551

Buproprion is contraindicated in:

Answer 551

Anorexia, Bulemia, Seizure disorders bc the drug lowers the seizure threshold

Question 552

1 - ß

Answer 552

Power of a study = the probability of seeing a difference when there is one ß is a type II error

Question 553

Positive selection happens in the

Answer 553

cortex double positives (CD4 CD8) are tested to see if they recognize self-antigen

Question 554

Negative selection happens in the

Answer 554

medulla do cells recognize self too much?

Question 555

Nitroprusside

Answer 555

Balanced arterio and venous dilator --\> SV maintained bc changes are balances tx of hypertensive emergencies reduces preload and afterload

Question 556

Phenotypic mixing

Answer 556

Genome is unchanged, new virions acquire new capsid proteins from other virus; Subsequent progeny will revert bc new capsid proteins not encoded for

Question 557

Growth factor involved in tissue regeneration and repair

Answer 557

TGF-beta

Question 558

Expressing unacceptible feelings through actions

Answer 558

Acting out immature defense mechanism

Question 559

Behaving as if an aspect of reality does not exist

Answer 559

Denial immature

Question 560

Transferring feelings to a more acceptable object

Answer 560

Displacement immature

Question 561

Using intellect to avoid uncomfortable feelings

Answer 561

Intellectualization immature

Question 562

Avoiding conflict by expressing hostility covertly

Answer 562

Passive aggression immature

Question 563

Attributing one's own feelings to others

Answer 563

Projection immature

Question 564

Justifying behavior to avoid difficult truths

Answer 564

Rationalization immature

Question 565

Responding in a manner opposite to one's actual feelings

Answer 565

Reaction formation immature

Question 566

Reverting to an earlier developmental stage

Answer 566

Regression immature

Question 567

Channeling impulses into socially acceptable behaviors

Answer 567

Sublimation mature

Question 568

Putting unwanted feelings aside to cope with reality

Answer 568

Suppression mature

Question 569

What drug to use in patients with recurrent C. Diff infection?

Answer 569

Fidaxomicin Bacteriocidal, minimal systemic absorption inhibits sigma subunit of RNA polymerase

Question 570

Genetically predisposed individuals who are slow acetylators are at greater risk of developing

Answer 570

drug induced lupus

Question 571

Lymph from the testes drains to the

Answer 571

para-aortic lymph nodes lymph from the scrotum drains to the superficial inguinal lymph nodes

Question 572

What antipsychotics carry the highest risk for developing hyperglycemia/dsylipidemia?

Answer 572

Clozapine Olanzapine Both second generation antipsychotics

Question 573

The H band contains

Answer 573

only thick filaments

Question 574

The I band contains

Answer 574

thin filaments

Question 575

MOA Thiazide diuretics, ie Clorthalidone

Answer 575

inhibit the Na/Cl cotransporter in the DCT --\> increased excretion of Na and H2O, as well as H and K Increases distal tubular Ca reabsorption

Question 576

Fever and sore throat in a patient with hyperthyroidism, being treated, should raise concern for

Answer 576

thionamide-induced agranulocytosis thionamides = methimazole, propylthiouracil MOA - inhibit thyroid peroxidase which impairs iodine organification

Question 577

Uses for propylthiouracil

Answer 577

useful in 1st trimester of pregnancy, and in thyroid storm, as it decreases peripheral T4 to T3; can cause agranulocytosis (neutrophils

Question 578

The recurrent laryngeal nerves innervate all of the intrinsic muscles of the larynx except

Answer 578

the cricothyroid muscle. Paresis of vocal cords innervated by the left recurrent laryngeal nerve can cause hoarseness Left atrial enlargement can sometimes cause left recurrent laryngeal nerve impingement

Question 579

Mitral stenosis can cause left atrial dilitation sufficient to impinge on the left recurrent laryngeal nerve. Dx?

Answer 579

Ortner syndrome

Question 580

MOA Pyridostigmine

Answer 580

long-acting AChE inhibitor symptomatic treatment of MG

Question 581

Tensilon test

Answer 581

infusion of a short-acting AChE inhibitor ie edrophonium if symptom improvement --\> myasthenic crisis if no symptom improvement --\> cholinergic crisis - muscle is refractory to impulse bc AChE dose was too high

Question 582

Hepatosplenomegaly, neurologic regression, cherry res spot on macula in infancy

Answer 582

Niemann-Pick disease sphingomyelinase deficiency accumulation of sphingomyelin

Question 583

Mutations involving the trypsinogen of SPINK1 genes

Answer 583

hereditary pancreatitis trypsinogen activates prematurely before reaching the duodenum, or cannot be inactivated --\> autodigestion

Question 584

In a patient with mitral regurgitation, the most reliable auscultatory finding indicating high regurgitrant volume (severe MR) is

Answer 584

left sided S3 gallop

Question 585

Prostaglandin E1 antagonist Pregnancy termination What medication?

Answer 585

Misoprostol

Question 586

Progesterone antagonist, glucocorticoid antagonist Pregnancy termination What drug?

Answer 586

Mifepristone

Question 587

transient hypercoagulable state that can occur during the first few days of warfarin therapy

Answer 587

warfarin-induced skin necrosis warfarin inhibits proteins C and S (natural anticoagulants present in the blood)

Question 588

Which cranial nerves have their nuclei located in the medulla?

Answer 588

CN IX CN X CN XII

Question 589

Which cranial nerves have their nuclei located in the pons?

Answer 589

CN V, VI, VII, VIII

Question 590

Which cranial nerves have their nuclei located in the midbrain?

Answer 590

CN III, IV

Question 591

Infection of the cavernous sinus affects what nerves?

Answer 591

cavernous sinus infection CN III, IV, VI --\> varying degrees of opthalmoplegia V1 and V2 of CN V - hypo or hyperasthesia

Question 592

What are the muscles of mastication?

Answer 592

Close jaw - masseter, temporalis, medial pterygoid Open jaw - lateral pterygoid

Question 593

Leptin decreases the production of:

Answer 593

Neuropeptide Y (a potent appetite stimulant) in the arcuate nucleus of the hypothalamus --\> decreased appetite

Question 594

Leptin stimulates the production of:

Answer 594

POMC - propiomelanocortin - in the arcuate nucleus POMC gets cleaved to make alpha-melanocyte-stimulating hormone, which inhibits food intake (increases satiety)

Question 595

HIgh extracellular K levels directly stimulate what cells in the kidney?

Answer 595

Principal cells (basolateral Na/K pump) --\> secretion of K into tubular fluid; Elevated K levels also increase aldosterone secretion

Question 596

Effect of alkalosis on K

Answer 596

H/K exchange, K lost ino order to get H -- alpha-intercalated cells

Question 597

How is K reabsorbed along the nephron?

Answer 597

100% filtered 65% reabsorbed at PCT always 25-30% reabsorbed via Na/K/2Cl exchanger in the ascending loop of Henle always Possible K secretion by principal cells in DCT/collecting duct End result - 10-110% of initial K

Question 598

Buspirone is effective for, not effective for...

Answer 598

Effective for treating GAD but not panic disorder; Slow onset of action (2 weeks to take effect)

Question 599

The presence of hemosiderin-laden macrophages (golden cytoplasmic granules) in pulmonary alveloi indicates:

Answer 599

Chronic elevation of pulmonary capillary hydrostatic pressures, most commonly as a result of left-sided HF

Question 600

Best ways to diagnose herpes simplex

Answer 600

1. PCR 2. viral culture (low sensitivity) 3. Tzanck smear (not the same as a gram stain) 4. direct fluorescence antibody

Question 601

What do absence seizures look like on EEG?

Answer 601

3 Hz generalized spike and slow wave EEG pattern \<10 seconds occur mainly in children 1st line ethosuximide, 2nd line sodium valproate

Question 602

Name two selective vasodilators of coronary vessels

Answer 602

Adenosine Dipyridamole Can cause coronary steal due to vasodilation of nonischemic areas, overall reduction in blood flow to ischemic areas --\> hypoperfusion and worsening of existing ischemia; Can use these drugs to TEST amount of coronary vasodilation

Question 603

The short gastric veins drain:

Answer 603

The fundus of the stomach to the splenic vein; Splenic vein joins with inferior mesenteric vein and joins the portal vein (to liver); Splenic vein thrombosis --\> back up into gastric veins --\> gastric varices in fundus

Question 604

The azygous vein drains

Answer 604

esophageal veins into the SVC

Question 605

Common causes of splenic vein thrombosis (seen as gastric varices due to back up of blood flow)

Answer 605

Pancreatitis, pancreatic cancer

Question 606

Inheritance pattern for CAHs: 21-hydroxylase deficiency; 11 beta-hydroxylase deficiency; 17 alpha-hydroxylase deficiency

Answer 606

AR

Question 607

Primary adrenal insufficiency (low Na, high K, high chloride, low bicarb = non-anion gap metabolic acidosis) involves autoantibodies to:

Answer 607

All three zones of the adrenal cortex aka Addison's disease; exogenous ACTH does not stimulate cortisol production

Question 608

Major rate-limiting enzyme in glycolysis

Answer 608

PFK-1 Fructose 6P --\> Fructose-1,6-bisP

Question 609

How does galactose enter glycolysis?

Answer 609

Galactose --\> Galactose-1-P --\> Glucose-1-P --\> Glucose-6-P

Question 610

How does mannose enter glycolysis?

Answer 610

Mannose --\> Mannose-6-P --\> Fructose-6-P

Question 611

Fetal hemoglobin is made of:

Answer 611

alpha2 gamma2

Question 612

Heparin-induced thrombocytopenia is caused by antibodies to:

Answer 612

heparin and platelet factor IV

Question 613

MOA of Hirudin Lepirudun, Argatroban

Answer 613

Direct thrombin inhibitors; do not require antithrombin III use to treat HIT (along with stopping heparin)

Question 614

ADP receptor inhibitor

Answer 614

Clopidogrel, Ticlopidine inhibit ADP-mediated platelet aggregation Useful following percutaneous coronary intervention, treatment of unstable angina, non Q-wave MI

Question 615

GpIIb/IIIa inhibitor

Answer 615

Abciximab Eptifibatide Tirofiban Use post PCI in ACS

Question 616

MOA Dipyridamole and Cilostazol

Answer 616

inhibit platelet aggregation PDE inhibitors --\> increase cAMP

Question 617

Use: Clonidine

Answer 617

Clonidine is an alpha-2-receptor agonist; Use in children with ADHD who failed methylphenidate

Question 618

Name the broad-spectrum anticonvulsants

Answer 618

Valproic acid Levetiracetam Topiramate Lamotrigine

Question 619

Avoid narrow-spectrum anticonvulsants ie carbamazepine, gabapentin, phenobarbital, phenytoin in treated generalized seizures because

Answer 619

they may aggregate the symptoms; use only with focal-onset seizures

Question 620

Chemotherapy-induced emesis can be ameliorated by 3 drug classes. Give an example of each: Dopamine receptor antagonists; 5HTs receptos antagonists; Neurokinin 1 (NK1) receptor antagonists

Answer 620

Dopamine receptor antagonists - Prochlorperazine, Metoclopramide 5HT3 receptor antagonists - Ondansetron, Granisetron NK1 receptor antagonists - Aprepitant, Fosaprepitant

Question 621

Treat hyperemesis of pregnancy with what antihistamine?

Answer 621

Promethazine

Question 622

How to assess statistical significance?

Answer 622

Confidence interval does not contain the null (0) value; Values can be positive or negative, but do not include 0 in order to be statistically significant

Question 623

What does a confidence interval of 95% mean?

Answer 623

That is the study was repeated 100 times, 95 times out of 100, the results would lie within the range given.

Question 624

Triglyceride metabolism TG --(lipase)--\> Glycerol + FA What happens to the glycerol and FA?

Answer 624

Glycerol --(glycerol kinase)--\> Glycerol-3-P --\> DHAP DHAP has 2 fates --\> glycolosis OR gluconeogenesis FAs undergo ketogenesis/betaoxidation

Question 625

Reactive arthritis most commonly follows infections with:

Answer 625

Shigella Salmonella Campylobacter Yersinia Chlamydia Bartonella \*immune complexes\*

Question 626

Symptoms related to the \*autoimmune\* response of Gravves disease

Answer 626

exopthalmous pretibial myxedema

Question 627

The most common ankle sprain involves what ligament?

Answer 627

Anterior talofibular ligament - pain and ecchymosis of anterolateral aspect of the ankle; Due to inversion of the plantar-flexed foot