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AM- STEP1 > Things to know 3 > Flashcards

Things to know 3 Flashcards

1
Q

Langerhan histocytes two markers

A

S-100

CD1a

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2
Q

G6PD drugs

A

” Spleen Purges Nasty Inclusions From Damaged Cells”

Sulfonamides 
Primaquine 
Nitrofurantonin 
Isoniazid 
Fava beans 
Dapsone 
Chloroquine
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3
Q

Woke up peeing red
Pancytopenia
Anemia
Hypercoagulability

A

Paroxysmal nocturnal hemoglobinuria (PNH)

Mutation PIGA
Deficiency: glycosylphosphatidylinositol (GPI) anchor
Deficiency: CD55 CD59 (Decay accelerating factor DAF)

Causes complement mediated lysis of RBCs

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4
Q

Misoprostol

A

PGE1 analog

Increase production and secretion of gastric mucus barrier

Decrease gastric acid secretion

Induction of labor

Diarrhea

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5
Q

Tx MM

A

Proteasome inhibitor

Borteozomib
- boronic acid containing dipeptidase

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6
Q

Sulfasalazine

  • MOA
  • Use
  • Adverse
A

Combo of sulfapyridine (antibacterial) and 5- aminosalicylic acid (anti-inflammatory)

Activated by colonic bacteria

UC and chrons

Nausea, sulfa toxicity
Oligospermia** (reversible)

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7
Q

Cancer drug causes

1) Pulmonary fibrosis
2) Hyperpigmentation
3) Nephrotoxicity, Neurotoxicity
4) Megaloblastic anemia, myelosuppression
5) Redness, swelling and pain on palms or soles
6) Hepatotoxicty
7) Cardiotoxicity
8) Convulsions, dizziness, ataxia
9) Mouth ulcers
10) Alopecia
11) Neuropathy and hypersensitivity
12) Areflexia, peripheral neuritis, constipation
13) Nephrotoxicity, peripheral neuropathy, ototoxicity
14) Diarrhea and myelosuppression
15) Hemorrhagic cystitis
16) Hemorrhage, blood clots, impaired wound healing
17) Rash only
18) Rash, Elevated LFTs, diarrhea
19) Fluid retention
20) Increased risk of thromboembolic events

A

1) Methotrexate, Bleomycin, Busulfan
2) Bleomycin, Busulfan
3) Cladribine
4) Cytarabine
5) 5-fluorouracil
6) Methotrexate
7) Doxorubicin, Daunorubicin , Trastuzumab (Herceptin)
8) Nitrosoureas
9) Methotrexate
10) Doxorubicin, Daunorubicin, Etoposide, teniposide
11) Paclitaxel
12) Vincristine, Vinblastine
13) Cisplatin, carboplatin
14) Irinotecan, topotecan
15) Cyclophosphamide, ifosfamide
16) Bevacizumab
17) Erlotinib
18) Cetuximab
19) Imatinib
20) Tamoxifen, Raloxifene

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8
Q

PAX8-PPAR gamma associated with

A

Follicular carcinoma of thyroid

- RAS mutation

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9
Q

Short 3rd and 4th finger

A

Pseudohypoparathyroidism type 1 A

G3 protein alpha subunit defective

Increased PTH but unresponsive
Decreased Ca

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10
Q

MAO inhibitors

A

Mom Take Serotonin Increasing Pills

MAO inhibitors
Tranylcypromine
Selegiline
Isocarboxazid 
Phenelzine

Increase level of amine NT (NE, 5-HT, dopamine)

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11
Q

Antigenic shift caused by

A

Reassortment

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12
Q

How does a Statin work

A

Increase transcription of HMG-CoA reductase

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13
Q

Diphenhydramine MOA and receptor

A

Antagonist at Muscarinic-3 (M3) receptors

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14
Q

Athletic dilated heart with normal function. What are the findings?

A. Congestive cardiomyopathy
B. Diastolic dysfunction
C. Eccentric hypertrophy
D. Hypertrophic cardiomyopathy
E. Increased myocardial stiffness
A

C. Eccentric hypertrophy

(in-line or in-series) building and enlargements of muscle cells and fibers

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15
Q

Thick heart thats normal sized (not dilated ) is build from

A

concentric hypertrophy (parallel building) and enlargement of muscle cells

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16
Q

Thickening of left ventricular wall, HTN, effects of these in cardiac muscle

Transcription Factor c-JUN
beta-Myosin
Heavy Chain
Endothelin

A

Hypertrophy
- C-jun= increase transcription –> increase cell size and/or number of cells

Increase in myosin heavy chain

Increase Endothelin
- increased because endothelin causes vasoconstriction

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17
Q

COPD effect on pulmonary vascular smooth muscle

  • Decrease in
A

COPD –> hypoxemia –> alveoli constrict in attempt to send blood to more diffused part of lung –> high pressure in pulmonary circuit –> atherosclerosis of pulmonary trunk, smooth muscle hypertrophy of pulmonary arteries and intimal fibrosis so less vasodilated happening and less endothelial nitric oxidase synthase production

Decrease in nitric oxidase synthase production

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18
Q

Cog wheel rigidity
Difficulty writing and walking
Bland facial expressions
Tremor in both hands

Inclusion?

A

Alpha-synuclein (intracellular eosinophilic inclusion)

Parkinsons

Also see loss of dopaminergic neurons (depigmentation) in substantia nigra pars compacta

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19
Q

Tx for Kaposi Sarcoma

A

Anti-neoplastic

IFN-alpha

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20
Q

IFN-alpha uses

A 
Chronic Hep B and C
Kaposi Sarcoma
Hairy cell leukemia
Condyloma acuminatum
RCC
Malignant melonma
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21
Q

IFN-beta use

A

Multiple sclerosis

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22
Q

IFN-gamma use

A

Crhonic granulomatous disease

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23
Q

Patient has unilateral Renal Artery stenosis

Effect on

  • Total peripheral resistance
  • Plasma Renin Activity
  • Serum Aldosterone Concentration
A

Total peripheral resistance= Increase

Plasma Renin Activity= Increase

Serum Aldosterone Concentration= Increase

Kidneys starved for blood, think low blood pressure. So release factors to increase pressure via RAAS cascade

  • Increase renin
  • Release aldosterone, increase blood pressure –>
  • Increase total peripheral resistance
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24
Q

Histological seen in heart 7 days after MI

A

Erythrocytes, cellular debris, macrophages, and early granulation tissue

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25
Q

Post MI

1) Coagulation necrosis of myocardial fibers with no inflammatory cell infiltrate
2) Contraction band necrosis of myocardial fibers
3) Erythrocytes, cellular debris, macrophages, and early granulation tissue
4) Extensive fibrous connective tissue

A

1) 0-12 hrs
- Early coagulative necrosis release of necrotic cell content into blood
- Edema, hemorrhage, wavy fibers

12-24 hrs

  • Neurophils appear
  • Reperfusion injury associated with generation of free radicals
  • Leads to hypercontraction of myfibrils through increase free calcium influx

2) 12-24 hrs

3) 7-10 days
- Macrophages
- Granulation tissue at margins

4) 2 weeks

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26
Q

63 y.o w/o emphysema gets HA, myalgia, and rising temp. Dry cough. No bacteria on gram stain. Severe pneumonia. Specialized culture shows gram negative rods. Responds to macrolide Ab. This infection was most likely acquired from which of the following?

A. Inhalation of aerosols from an environmental source
B. Inhalation of dust from bird droppings
C. Inhalation of respiratory secretions from an infected animal
D. Inhalation of respiratory secretions from another infected person
E. The patients normal flora

A

Inhalation of aerosols from an environmental source

Legionella
- Gram Neg rod that stains poorly

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27
Q

Repetitive unilateral shooting/ shock like pain in face. Triggered by chewing, talking touching certain parts of face. Lasts seconds to minutes. Increase in intensity and frequency over time

Tx

A

Trigeminal neuralgia

Carbamazepine
- Blocks Na channels

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28
Q

Tubular osmolarity Hypotonic, Isotonic or hypertonic in dehydrated patient. Compare nephron to serum

1) PCT
2) Macula Densa
3) Medullary Collecting Duct

A

1) PCT
- Isotonic always

2) Macula Densa
- Ascending loop and distal tubule
- Reabsorbs and dilutes tubular fluid –> Hypotonic

3) Medullary Collecting duct
- Draws H20 and urea out
- Hypertonic

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29
Q

Sunburst pattern

- Histology

A

Osteosarcoma

Pleomorphic osteoid-producing cells

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30
Q

Bone tumor
1) Anaplastic small blue cells of neuroectodermal origin

2) Tumor of malignant chondrocytes
3) Neoplastic mononuclear cells that express RANKL and reactive multinucleated giant cells
4) Neoplastic plasma cells in sheets

A

1) Ewing
2) Chondrosarcoma

3) Giant Cell Tumor
- osteoclastoma

4) Multiple myeloma

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31
Q

Calcium infusion which will be increased?

A) 7- Dehydrocholesterol
B) 1,25 Dihydroxycholecalciferol
C) 24,25 Dihydroxycholecalciferol
D) Previtamin D3
E) Vitamin D3
A

C. 24,25 dihydroxycholecalciferol

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32
Q

Kidney spinal level

Spleen level

A

Kidney T12- L3

Ribs 9 and 10

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33
Q

Spermatogenesis

A

“Gonium” is going to be a sperm;
“Zoon” is Zooming to egg

Spermatogonium

  • Diploid, 2N 2C
  • 46 single chromosomes

Primary spermocyte

  • Diploid, 2N, 4C
  • 46 sister chromatids
  • division of X and Y at end of meiosis I

Secondary spermatocyte

  • Haploid, 1N, 2C
  • division of X-X
  • division of Y-Y at meiosis II

Spermatid
- 1N 1C

Spermatozoon

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34
Q

47 XXY male, one X chromosome from patients father error occurred at what stage of spermatogenesis?

A

Primary spermatocyte

- division of X and Y occurs at end of meiosis I

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35
Q

Spermiogenesis

A

Spermatid Haploid (1N, 1C ) –> Mature spermatozoon (1N, 1C) with acrosome, tail

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36
Q

47 XYY male, both Y from father, occur at what stage of spermatogenesis

A

Secondary spermatocyte

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37
Q

Lab findings on patient with polycystic kidney disease and elevated creatinine concentration

  1. HCO3
  2. PO4
  3. PTH
A

Renal failure

Increase PO4
Increase PTH
Decrease HCO3

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38
Q

Patient with elevated 17-hydroxyprogesterone

A

21-hydroxylase deficiency

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39
Q

Barefoot on beach
Cellulitis on lower extremity
Blister formation
Gram negative lactose fermenting organism

A

Vibrio vulnificus

  • swimming with brackish water
  • Shucking oysters

Tx Tetracycline or 3rd generation cephalosporin

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40
Q

Endothelin-1

A

Stimulated myofibroblasts contraction

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41
Q

Thrombomodulin

A

As thrombin is swept away in the blood stream and encounters uninjured vessels, converted to anticoagulant through binding thrombomodulin.

Protein on surface of endothelial cells

Complex Activates protein C

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42
Q

Decreased gastric hydrogen chloride production

Decreased mucosal thickness and hyperplasia of enterochromaffin-like cells.

Resemebles what disease?

A

Chronic gastritis

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43
Q

Appendectomy, Anesthesia by mask to quickly anesthetize would have what characteristic

A. High blood solubility
B. High cerebrospinal fluid solubility
C. High lipid solubility
D. Low blood solubility
E. Low lipid solubility
A

D. Low Blood solubility

CNS drugs must be lipid soluble (cross the bbb)

Drugs with low solubility in blood= rapidly induction and recovery time

Increase solubility in lipids= increased potency

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44
Q

Homeless man, alcohol smell. Bronzed skin and spider angiomata on chest.

Elevated MCV
Elevated segmented neutrophils
Decreased RBC folate
Normal B12

Increase or decrease in methymalonic acid / homocysteine

A

Mehtylmalnic acid normal
Homocysteine increased

Alcoholic –> Folate deficiency

Folate and B12 needed for Homocysteine –> Methionine –> DNA synthesis

B12 only needed for Methylomalonic acid –> succinic acid –> myelin synthesis

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45
Q

Rib at 7th cervical vertebrae.
7th cervical vertebrae –> thoracic identity resulted from which alteration in HOX

A. Expression of HOX gene normally expressed only caudal to C-7
B. Expression of HOX gene normally expressed only cranial to C-7
C. Lack of expression of a HOX gene normally expressed at C-7
D. Overexpression of a HOX gene normally expressed at C-7
E. Underexpression of a HOX gene normally expressed at C-7

A

A. Expression of HOX gene normally expressed only caudal to C-7

Hox responsible for appendages

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46
Q

Vaginal pain with urination
Bilateral vesiculoulcerative lesions of the introitus

Antimicrobial therapy?
A. Acyclovir
B. Amoxicillin/ clavulanate
C. Ganciclovir
D. Penicillin
E. Vidarabine
A

HSV

A. Acyclovir

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47
Q

Non-painful ulcerated indurated genital lesion

A

Syphilis

Pencillin G

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48
Q

Increased number of megakaryocytes

Nose bleeds and easy bruising
Decreased platelet count

A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
B) Decreased binding of Gpla/IIa to collagen
c) Decreased concentration of the Gp1b/IX complex
D) Decreased concentration of the GpIIb/IIIa complex
E) Decreased synthesis of thromboxane A2
F) Deficient binding of von Willebrand factor to the Gp1b/IX complex

A

ITP

A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex

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49
Q

A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
c) Decreased concentration of the GpIb/IX complex
D) Decreased concentration of the GpIIb/IIIa complex
F) Deficient binding of von Willebrand factor to the GpIb/IX complex

A

A) ITP

C) Bernard-Soulier

D) Glanzman thromboasthenia

F) Von Willebrand def

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50
Q

Relative risk reduction?

W recurrent stroke standard tx: 0.12
M recurrent stroke standard tx: 0.24
Overall recurrent stroke standard tx: 0.18

W New tx: 0.04
M New tx: 0.08
Overall : 0.06

A

Relative risk reduction= 1- RR

1- Relative risk

RR= risk of developing dz in exposed ground/ risk of developing dz in unexposed group

0.04/ 0.012= 0.3333
1- 0.33333= 0.67

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51
Q

Raynauds phenomenon avoid which drugs

A

Phenylephrine

- avoid alpha agonists

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52
Q

Blistering lesions in sun exposed areas. Recurrent hx of these lesions.

Increased Total porphyrin
Increase Urine uroporphyrin III

Precursor to uroporphyrin?

A

Dx: Porphyria

Precursor= Succinyl-CoA

Defective uroporphyrinogen decarboxylase= porphyria cutanea tardia.

Succinyl-CoA combines with glycine to form ALA start of heme synthesis

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53
Q

Red spots on shins, joint pains and fatigue.

Purpura on lower extremities

Liver edge palpated 4 cm below margin

AST 142 
ALT 154
Positive Hep C virus RNA
Positive anti Hep C virus Ab
Positive Cryoglobulins
Decreased C4

Urine Protein 4+

Renal damage due to?

A

Cryoglobulinemia secondary to hepatitis C

Cryoglobulins in kidney cause nephrotic syndrome by settling in kidney

Type III HS

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54
Q 
Enlarged tongue
Progressive weakness
Hypotonia
Cardiomegaly
Increased glycogen

Impairment of what enzyme?

A. Branching enzyme
B. Glucose-6-phosphatase
C. alpha-1,4-glucosidase
D. Glycogen synthase
E. Phosphoglucomutase
A

C. Alpha-1,4- glucosidase

Pompe disease

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55
Q

Necrosis of bacteria infections

A

Liquefactive

Or brain infarct

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56
Q

Necrosis of TB or systemic fungi

A

Caseous necrosis

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57
Q

NE infusion. After 2 min coronary dilation

A) Adenosine
B) Angiontensin II
C) Epinephrine
D) Histamine
E) Thromboxane A2
A

Adenosine

Adenosine causes coronary dilation mediated by A2 receptors

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58
Q

Cecum metastasis to liver pathway

A

Ileocolic –> superior mesenteric –> portal –> right hepatic branch of portal

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59
Q

Vertical gaze palsy

Enlargement of third and lateral ventricles. Location of mass?

A

Pineal gland

- Pinealoma

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60
Q

Fever
Large flaccid, Bullous lesions over trunk and abdomen

Additional finding?

A

S. Aureus
- Impetigo

Positive nares culture for toxin producing S. aureus

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61
Q

Tx Malignant hyperthermia

A

Dantrolene

Decreases Ca release from Sarcoplasmic reticulum

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62
Q

Antifungal which targets glucan expression on the fungal cell surface

  • type
  • use
  • adverse
A

Capsofungin
Anidulafungin
Micafungin
(All Echinocandins)

Inhibit cell wall synthesis by inhibiting synthesis of beta-glucan

Tx: invasive aspergillosis, candida

GI upset
Flushing (histamine release)

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63
Q

Amphotericin B

- MOA

A

Binds ergosterol

- forms membrane pore that allows leakage of elecrtrolytes

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64
Q

Aspirin overdose

pH
PCo2
HCO3

A

Salicylates
- cause increase anion gap metabolic acidosis with immediate hyperventilation as compensatory

Decrease pH
Decrease HCO3
Decrease PCO2 from hyperventilation

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65
Q

14 y.o girl, heavy menstrual flow. Frequent nosebleeds and easy bruisability. Father has problem with nosebleeds and clotting. Mild gum bleeding and mile ecchymoses.

Decreased Hemoglobin
Decreased Hematocrit
Normal platelets
Prolonged Bleeding time
Normal PT
Prolonged PTT
A

Von Willebrand deficiency

Prolonged BT
Prolonged PTT

Normal platelets so not TTP
Normal PT so not Vit K
(Vit K def= increase PT and PTT)

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66
Q

Heart transplant
One year later, increase BP and creatinine. Which immunosuppressive drug would cause this?

A) Azathioprine
B) Corticosteroid
C) Cyclophosphamide
D) Cyclosporine
E) Muromonab CD3
A

D) Cyclosporine

  • Nephrotoxicity
  • HTN
  • Gingival hyperplasia
  • Hirsutism

Azathioprine
- Pancytopenia

Cyclophosphamade

  • Hemorrhagic ycstitis
  • SIADH
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67
Q

CCK is released from

A

Enteroendocrine cells (I cells) found in upper small intestine (duodenum and jejunum)

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68
Q

Prolong QT due to decrease of what activity

A

Outward (delayed) rectify potassium channel

Not inward activating potassium channel

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69
Q

Vitamin from dairy

A

Vit D3

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70
Q

Organisms that cause microcytic anemia

A

Necator

Ancylostoma

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71
Q

Kidney with dilated ureter/ calyx in image

A

Tubular atrophy

Small and nonfunctional kidnye

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72
Q

Man with PKD
Elevated BUN/Cr

pH?
PCO2?
HCO3?

A

Renal failure

Metabolic acidosis

  • Decreased pH
  • Normal PCO2
  • Decreased HCO3
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73
Q

Neonatal respiratory distress due to deficiency in

A

Dipalmitoylphosphatidylcholine

Pulmonary surfactant composed of: lecithins (most important is dipalmitoylphosphatidylcholine)

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74
Q

Surfactant subtypes

A

A and D pulmonary host defense

B and C reduce tension

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75
Q

Supplemented in chronic kidney disease

A

erythropoietin

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76
Q

Patient with Diabetes has diarrhea due to

A

Motility disorder

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77
Q

Bulimia values

K
HCO3
Anion Gap
pH

A

Increase pH
Increase HCO3
Decrease K
Normal Anion gap

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78
Q

Diabetic ketoacidosis

PCO2
HCO3
Anion Gap

A

Increased Anion gap
Decrease HCO3
Decreased PCO2

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79
Q

Coccus in chains

Dental procedure

A

Viridians Streptococcus

Partially green on blood agar

Optochin resistant

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80
Q

What would cause ciprofloxacin for UTI to not work

Alendronate
Calcium carbonate
Ezetimibe
Hydrocholorthiazide
Simvastatin
A

Calcium carbonate

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81
Q

Dont take ciprofloxacin with

A

antiacids

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82
Q

2 month old
Fever, vomiting, diarrhea
Viral particles with a wheel- like shape

A

Rotavirus

Segmented dsRNA viru
(reovirus)

No envelop

Icoshedral

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83
Q

Primary pericarditis most commonly caused by

A

virus

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84
Q

A study is conducted to assess the incidence and outcome of subarachnoid hemorrhage in a midwestern state. The annual incidence of this condition is 15 per 100,000 people and the annual mortality rate is 6 per 100,000 people. Assuming that the incidence remains constant, which of the following is the case fatality rate for this condition in this state?

A

40%

Case-fatality rate= proportion of people with a particular disease that die as a result of that disease.

Compares number of cases to the number of fatalities

6/15= 40%

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85
Q

20 y.o 2 week history of fever, shaking chills, HA, fatigue, joint and muscle pain. Summer lifeguard in long Island. No spleen. Small intraerythrocytic rings. Negative Plasmodium spp.

  • Disease
  • Location
  • Vector
  • Blood smear
  • Tx
A

Babesia

Fever and hemolytic anemia
Northeastern U.S
Increase risk with asplenia

Ixodes tick

Ring form
Maltese Cross

Tx: Atovaquone + azithromycin

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86
Q

Antibiotic tx for meningitis –> develop hypotension and bilateral flank pain

A

Waterhouse- Friedrichsen syndrome

Acute primary adrenal insufficiency due to adrenal hemorrhage

Test with ACTH stimulation test

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87
Q

Condition in which slow recovery from paralysis

A

Pseudocholinesterase deficiency

Slow at breakdown choline easters

Sensitive to anesthetic drugs like succinylcholinen and mivacurium

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88
Q

5 cm blind outpouching on terminal ileum. Pathology will show

A

Hetertopic gastric mucosa

Meckel diverticulum

  • Partial closure of vitelline duct
  • May have heterotropic gastric and/or pancreatic tissue
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89
Q

Splenectomy

Target erythrocytes due loss of what part of spleen

A

Red pulp

Primarily a filter designed to screen and eliminate defective or foreign cells

White pulp= T cells

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90
Q

Location of most active cell division in epithelial repair

A) Base of crypt
B) Brunner glands
C) Peyer patches
D) Top of Villi

A

A) Base of crypt

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91
Q

1 wk hx SOB
Carotid artery shows light upstroke to be brisk and downstroke to fall precipitously.

Aortic coarctation
Aortic regurgitation
Aortic stenosis
Mitral regurgitation
Mitral stenosis
Ventricular septal defect
A

Aortic regurgitation

Hyperdynamic pulse

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92
Q

Vancomycin-resistant Enterococcus mechanism

A

VRE strain of enterococcus that has acquired resistance to vancomycin through the uptake of a PLASMID that has the resistance

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93
Q

Crush injury
Damage to which of the following is most likely to preclude restoration of normal tissue architecture and pulmonary function?

A) Basement membrane
B) Capillaries
C) Fibroblasts
D) Macrophages
E) Mast cells
F) Type I pneumocytes
A

A) Basement membrane

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94
Q

Cor pulmonale

A

Pulmonary hypertension heart disease

Consists of right ventricular hypertropy, dilation and potentially failure secondary to pulmonary hypertension caused by disorders of the lung or pulmonary vasculature

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95
Q

Scleroderma risk of developing

A

Pulmonary htn

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96
Q

Epilepsy driving rule

A

1 year w/o seizure

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97
Q

Blood dots on tongue and lips
Progressive SOB
Nosebleeds
CLubbing nails

Disease?
What is causing SOB

A

Hereditary hemorrhagic telangiectasia (osler-weber-rondu)

Arteriovenous malformations (AVMS)
- atrial septal defect
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98
Q

Tx for IBD

- MOA

A

Tx Diarrhea
Loperamide

Agonist at u-opiod receptors
SLows gut motility
Poor CNS penetration

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99
Q

Multiple sclerosis pathogenesis of the disease

A

CD4 T lymphocytes activated by myelin basic protein

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100
Q

High BP
Hypokalemia
Metabolic alkalosis
Increased Renin and aldosterone

Administer captopril
- results in increase in renin

A

Renal artery stenosis

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101
Q

Renal osteodystrophy

A

Renal disease –> secondary hyperparathyroidism –> bone lesions

Hypocalcemia
Hyperphosphatemia

Thinning of bones

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102
Q

2 weeks back pain

Two lesions in spine

A

Metastatic carcinoma of the breast

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103
Q

Missing superior parathyroid gland

A

Abnormal migration of endoderm for the fourth pharyngeal pouch

3rd pouch: inferior parathyroid and thymus

4th pouch: superior parathyroid

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104
Q

Lung that is underventilated but well perfused. This condition will lead to an increase in

A

Physiologic shunt

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105
Q

Chloroquine tx for Malaria (plamodium vivax). Initial response good but recurretn parasitemia 2 months later. Why?

A

Chloroquine is ineffective on the exoerythroytic malarial tissue stages

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106
Q

Lower GI bleeding
Nothing on upper endoscopy or colonoscopy
Blood in stool

Cause of GI symptoms

A

Angiodysplasia

Tortuous dilation of vessels –> hematochezia

Right sided colon
Older adults
Confirmed by angiography

Associated with

  • Aortic stenosis
  • Von willebrand disease
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107
Q

6 hr hx fever and shaking chills
Took aspirin for fever
Blood pressure 102/60
Bilateral tenderness in costovertebral area

Increased Leukocyte count
4+ Leukocyte esterase
4+ nitrates

A

Leukomoid rxn

Acute pyelonephritis
+ nitrates

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108
Q

Leukomoid rxn

A

Increased white blood cell count, or leukocytosis which is a physiological response to stress or infection. Often describes the presence of immature cellls such as myelofibroblasts or red blood cell with nuclei in peripheral blood.

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109
Q

2 y.o fever sore throat rash
Widespread sandpaper like rash over extremities. Purulent exudate on tonsils. Streptococcus pyogenes (group A) infection. Which toxin?

A

Erythrogenic toxin

Cross link MHC II to TCR release IL-1, IL-2, IFN-gamma, TNF alpha –> shock

Fever rash shock
Scarlet fever
Toxic shock-like syndrome

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110
Q

Streptolysin O toxin

A

Protein degrades cell membrane

Rheumatic fever

Beta-hemolysis

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111
Q

Pancreatitis cant digest triglycerides due to deficiency of

A

Colipase

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112
Q

Alcohol wipe inactivates which viruses

A

Enveloped virion

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113
Q

1 week hx of low grade fever and joint pain. Chronic headaches takes ibuprofen several times daily. Maculopapular rash. 2+ protein. 10-20 WBC and eosinophils. Renal biopsy most likely to show

A

Inflammatory infiltrates in the interstitium

Acute pyelonephritis
- WBC in urine

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114
Q

Liver covered in yellow stuff

A

Fibrin

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115
Q

Low hemoglobin

A

Anemia

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116
Q

Hematocrit

A

Volume of RBC compared to total volume

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117
Q

Phase I reactions

- result

A

Oxidation
Reduction
Hydrolysis

Slightly more polar
Slightly more water soluble

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118
Q

Phase II reactions

- result

A

Methylation
Acetylation
Sulfation
Glucuronidation

Very polar
Inactive

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119
Q

Major manifestations

Familial chylomicronemia assoc with

Familial hypercholesterolemia assoc with

Familial dysbetalipoproteinemia assoc with

Familial hypertriglyceridemia

A 
Familial chylomicronemia 
- Acute pancreatitis
- Hepatomegaly
- Eruptive skin xanthomas 
(Tendon xanthomas)

Familial hypercholesterolemia

  • Premature MI
  • Tendon xanthomas
  • Corneal arcus

Familial dysbetalipoproteinemia

  • Premature MI
  • Palmar xanthomas

Familial hypertriglyceridemia

  • Pancreatitis risk
  • Obesity
  • Insulin resistance
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120
Q

Hypoglycemia in Type I DM can be induced by (3)

A
  1. Overdose of insulin
  2. Decreased carbohydrate intake (skipped meal)
  3. Physical activity/ exercise
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121
Q

Medullary thyroid cancer on histology

A

Nest of polygonal cells with congo red positive deposits

Polygonal or spindle shaped cells with extrameduallary amyloid deposits

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122
Q

Branching structures with interspersed calcified bodies

A

Papillary thyroid cancer

Psammoma bodies

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123
Q

Polygonal shaped cells with extramedullary amyloid deposits

A

Medullary thyroid cancer

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124
Q

Follicular hyperplasia with tall cells forming intrafollicular projections

A

Tall cell variant of papillary thyroid cancer

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125
Q

Pleomorphic giant cell nests with occasional multinucleated cells

A

Anaplastic thyroid cancer, aggressive

Often irregular giant cellsa dn biphasic spindle cells

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126
Q

Sheets of uniform cells forming small follicles

A

Colloid containing microfollicles suggests benign follicular adenoma

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127
Q

Fabry disease most at risk for developing

A

Renal failure

Neuropathic pain
Angiokeratomas
Telangiectasias
glomerular disease (proteinuria)
Cerebrovascular disease (stroke)
Cardiac disease (left ventricular hypertrophy)
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128
Q

13 yo girl. Blood pressure 152/91. Lack of secondary sexual characteristics and pelvic examination shows a blind vagina. Lab studies show hypokalemia and low testosterone and estradiol levels. Cytogenetic analysis shows 46, XY karyotype. What is deficient

A. 21-hydroxylase
B. 17a- hydroxylase
C. 11b-hydroxylase
D. Side chain cleavage enzyme
E. 5a-reductase
A

B. 17a- hydroxylase

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129
Q

Alpha cell tumor

A

Glucagonoma

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130
Q

Insulin increasing drugs

A

sulfonylureas

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131
Q

Spliceosomes remove introns at

A

GU at 5’ splice site

AG at 3’ splice site

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132
Q

What helps the mRNA exit the cytosol

A

poly A tail

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133
Q

What assists in ribosomal attachment to mRNA and prevents degradation of mRNA by 5’ exonucleases

A

5’ Cap

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134
Q

Androgenetic alopecia

- inheritance

A

Polygenic

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135
Q

Alkaline phosphatase does what

A

Promotes normal bone mineralization by increasing local concentrations of inorganic phosphorus

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136
Q 
Low grade fever
Skin rash
Started on face and spread down
8 y.o
LAD behind ears
A

Measles

- Togavirus

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137
Q

Progressive back pain
Intermittent fever
Vertebral boen destruction with fluid collection

A

Mycobacterium tuberculosis spondylitis (potts disease)

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138
Q

What promotes acen

A

Androgens

Not estrogen

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139
Q

First like tx for Gout

A

NSAIDS

- cyclooxygenase inhibitor

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140
Q

Chronic application of corticosteriods causes what to skin

A

Dermal atrophy

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141
Q

Osteoporosis histology description

A

Trabecular thinning with fewer interconnections

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142
Q

Pruritic skin rash
Pink papules symmetrically over anterior surface of shins and ankles
Hyperkeratosis with a thickened granular layer
Rete ridges with sawtooth appearance
Scattered colloid bodies

A

Lichen Planus

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143
Q

Lichen Planus features

A 
Pruritis skin rash
Pink Polygonal papules and plaques
Chronic lesions show white lacy markings
Hyperkeratosis
Lymphocyte infiltrates at dermoepidermal junction (interface dermatitis) 
Scattered esoinophilic, colloid bodies
Thickened stratum granulosum
- sawtooth appearance
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144
Q

Bluish tumor under nail bed

A

Glomus tumor (glomangioma) or a subungual melanoma

Glomangioma

  • Modified smooth muscle cells of a glomus body
  • fxn thermoregulation
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145
Q

Terbinafine

A

Inhibits synthesis of ergosterol of the fungal membrane by inhibiting enzyme squalene epoxidase

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146
Q

Patient 40 y.o with diabetes having incontinence issues

A

Overflow incontinence due to impair detrusor contractility or bladder outlet obstruction

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147
Q

Acute dystonic reaction

  • is what
  • due to
A

Spasmodic torticollis

Antipsychotic medication

D2 antagonism of nigrostriatal pathway

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148
Q

What do you have to restrict in patient with ornithine build up?

A

Proteins

Defect in urea cycle

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149
Q

Gingival hyperplasia

A

Phenytoin

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150
Q

Sudden onset of pain over right cheek lasting several seconds. Triggered by shaving or chewing. Shock like pain

Tx
MOA

A

Trigeminal neuralgia

Carbamazepine
- Reduces ability of Na channels to recover from inactivation

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151
Q

S. Pneumonae characteristics

A. Bacitracin sensitivity
B. Bile solubility
C. Catalase positivity
D. Complete hemolysis on agar
E. Growth in hypertonic saline
F. Optochin resistance
A

B. Bile solubility

Optochin sensitive

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152
Q

Bacitracin sensitive

A

Streptococcus pyogenes

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153
Q

Complete hemolysis

A

Group A Strep (s. pyogenes)

Group B Strep ( S. agalactiae)

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154
Q

Growth in hypertonic saline

A

gamma- hemolytic
No hemolysis

Enterococci
S. bovis

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155
Q

Optochin resistance

A

Viridans group streptococci

Bile insoluble

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156
Q

Tx Lyme disease

A

Doxycycline

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157
Q

More chloride in RBC

Enzyme responsible

A

Excess HCO3 transferred out of RBC in exchange for Cl

Carbonic anhydrase

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158
Q

Thickening of pleural membranes around whole lung

Disease
Due to
Histology

A

Mesothelioma
- Asbestos exposure

Spindle cell positive for cytokeratin

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159
Q

Central areas of whorled collagen fibers in lungs

A

SIlicosis
- inhaled silica

Nodules of whorled collagen fibers and dust-laden macrophages

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160
Q

Small cell lung cancer positive for

A

Chromogranin

- neuroendocrine marker

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161
Q

Thick fibrinous exudate and pus in histology of lung

A

Empyema

- assoc w/ pneumonia

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162
Q

Primary diffusion impairment due to

A

Pulmonary fibrosis
Emphysema

Impaired gas diffusion

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163
Q

Baby born to diabetic mother as risk for

A

Transient hypoglycemia

Glucose can cross but not insulin from mother

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164
Q

Superior sulcus tumor

A

Pancoast tumor

  • SVC syndrome
  • Horner syndrome
  • Spinal cord compression
  • Brachial plexus

Tumor in apex of lung

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165
Q

Schizoaffective disorder. On Haloperidol and sertaline

Found diffusely rigid without clonus

Elevated serum creatinine

Antidote?

A

Neuoleptic malignant syndrome

Elevated creatine kinase due to rhabdomyolysis

Tx dantrolene

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166
Q

Riboflavin deficiency

WHat enzyme impaired?
A. Fumarase
B. G6PD
C. HMG-COA reductase
D. Isocitrate dehydrogenase
E. Malate dehydrogenase
F. Succinate dehydrogenase
G. Succinate thiokinase
A

F. Succinate dehydrogenase

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167
Q

Brain tumor in HIV patient

A

Primary CNS lymphoma

  • arise from B cells
  • assoc with EBV
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168
Q

Ureter obstruction leads into increase in what in the nephron

A. Bowman space oncotic pressure
B. Glomerular filtration
C. Intraglomerular capillary hydrostatic pressure
D. Tubular hydrostatic pressure
E. Tubular oncotic pressure
A

Increased Tubular hydrostatic pressure

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169
Q

Overdose of theophylline can cause

A

Seizures and tachyarrhythmias

Cardiotoxicity
Neurotoxicity

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170
Q

Pneumocystis pneumonia vs aspergillus

A

Pneumocystis pneumonia
- diffuse bilateral interstitial infiltrates

Aspergillus
- dense infiltrate involving right upper lung lobe

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171
Q

Cytotoxic exotoxin organisms

A

Clostridium botulinum
Clostridium tetani
Corynebacterium diphtheriae

Promote host cell death

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172
Q

Hyaluronidase used by

A

S. aureus
Streptococcus pyogenes
Clostridum perfringens

DIgest extracellular ground substance and enhance ability to spread

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173
Q 
Fever and skin rash
Brazil
Headache
Retro-orbital pain
High fever
joint and muscle pain
Epistaxis
Rash all over body
Diffuse maculopapular rash
Scttered petechiae
Throbmocytopenia
A

Dengue fever

- mosquito

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174
Q 
Dysphagia
Dry mouth 
Blurred vision
Mydriasis
Poorly reactive pupils

Suggests

A

Clostridium botulinum toxin
- neurotoxin

Inhibit ACh release

Canned foods

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175
Q

Dynamic left ventricular outflow obstruction

A

Hypertrophic cardiomyopathy

Crescendo-decrescendo systolic murmur

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176
Q

Integrase function

A

After HIV enters host cell, transcribed into double stranded DNA by reverse transcriptase

Viral DNA then enters nucleus via integrase, inserts into host chromosomes and products viral mRNA

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177
Q

Swelling of knee and pain
Facial palsy 3 months ago
Hiking trip to New Hampshire
Knee swelling with no erythema

Tx

A

Lyme disease

Asymmetric arthritis, single knee joint

Encephalopathy with decreased memroy, somnolence and mood changes

Tx Doxycycline

  • Penicillin type Ab
  • Ceftriaxone
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178
Q

Nephrotic syndromes

  • proteinuria
  • albumin
  • feature

Does not have

Examples

A

Heavy proteinuria

Low albumin

Edema

No hematuria or red blood cell casts

Diabetic nephropathy
Membranous nephropathy
Minimal change disease

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179
Q

Nephritic syndrome

  • proteinuria
  • albumin
  • features
A

<3.5 proteinuria

Hematuria
Red blood cell casts

Azotemia
HTN

PSGN
Membranoproliferative
Lupus nephritis
IgA nephropathy

180
Q

Nephritic syndrome associated iwth normal complement levels

A

IgA neprhopathy

181
Q

Use to test pancreatic function

A

D-xylose

- monosaccharide

182
Q

Oliguria
High serum creatinine level
Intranasal ulcer that wont heal

Ab against?

A. Glomerular basement membrane
B. Smooth m. cells
C. Neutrophils
D. Erythrocytes
E. Platelets
F. Mitochondria
A

C. Neutrophils

Granulomatosis with polyangiitis (wegners)

Nasal mucosal ulcerations and glomerulonephritis

+ c-ANCA
( cytoplasmic staining anti-neutrophil cytoplasmic antibodies)

183
Q

Hamartoma of lung

A

Pulmonary chondroma

Coin lesion

Popcorn calcifications

Excessive growth of a tissue type native to organ

Would find cartilage tissue in biopsy sample

184
Q

Lung lesion with alveolar growth pattern without invasion

A 
Bronchioloalveolar carcinoma
(variatn of adenocarcinoma)
185
Q

Areas most susceptible to atherosclerosis

A

Branch points that encourage tubulent blood flow

Lower abdominal aorta
Coronary arteries

186
Q

Excessive bleeding in patient with renal dysfunction due to

A

Accumulation of uremic toxins

Impair platelet aggregation and adhesion

Prolonged bleeding
Normal platelet count
Normal PT and PTT

187
Q

Other side effect of ACE thats not cough and angioedema

A

Hyperkalemia

Increase creatinine

188
Q

Sore throat and fever
Mild tonsillar erythema and exudates

Clumped gram positive bacteria with polar granules that stain deeply with analine dyes

Pathogenesis?

A

Diphtheria

AB Exotoxin

  • B binds heparin-binding epidermal growth factor
  • A inhibits host cell protein synthesis by catalyzing the ADP-ribosylation of protein elongation factor EF-2

Impairment of protein synthesis

189
Q

Complete molecule karyotype

A

46, XX

only paternal DNA

190
Q

Jejunum removal requires what supplementation after

A

Decrease in gastric acidity as diminishes iron absorption

Iron absorption duodenum and proximal jejunum

191
Q

Ascorbic acid absorbed where

Pyridoxine absorbed where

Biotin absorbed where

Panthothenic acid absorbed where

A

Vit C: distal small bowel

Pyridoxine (B6) jejunum and ileum

Biotin (B7) small and large intestine

Panthothenic aicd (B5) small and large intestine

192
Q

Patients with panic disorder often develop

A

Agoraphobia

193
Q

Patients that undergo organ transplantation and are on immunosuppressive therapy at risk for what

Presentation

Biopsy shows

First line therapy
-MOA

Can cause

A

CMV reactivation

Fever, fatigue, abdominal pain, diarrhea

Ulcerations
Large cells iwth intranuclear eosinophilic inclusions, intracytoplasmic basophilic inclusions (owls eye)

Ganciclovir
- interferes with viral replication by competitvely inhibiting the incorporation of guanosine triphosphate into CMV stands by CMV DNA polymerase

Side effect

  • Neutropenia
  • Anemia
  • Thrombocytopenia
194
Q

Fever, HA, myalgia, maculopapular rash
Camping in appalachian mounts

Tx
- MOA

A

Rocky mountain spotted fever

Rickettsia rickettsii
- tick bite

Doxycycline
- Inhibits protein synthesis by binding 30s subunit

195
Q

Pruritis
Fatigue
Sister has Sjogren
+ Antimitochondria Ab

Histology of liver similar to what condition

A

Primary biliary cirrhosis
- chronic autoimmune liver disease characterized by destruction of small and mid-sized intrahepatic bile ducts resulting in cholestasis

Grast vs host disease

196
Q

Diazepam dont use with

A

Long acting benzodiazepam

Dont use with other CNS depressants

Alcohols
Barbiturates
Neuroleptics
1st generation antihistamines (chlorpheniramine)

197
Q

Right gaze

  • right eye: right
  • left eye: forward

Neutral normal

Left gaze
- both look left

Convergence: normal

A

Left internuclear ophthalmoplegia

Damage to medial longitudinal fasciculus

Lesion at left dorsal pons

198
Q

Bacteriodes tx

A

Gram negative anaerobic rods
(beta lactamase can break down penicillins)

Pipercillin + tazobactams

199
Q

Azithromycin use

A

Macrolide
50S

Inhibit protein synthesis

Chlamydia
Mycoplasma
Haemophilus influenza
Moraxella catarrhalis

200
Q

Ceftriaxone use against

A

H. influenzae
Klebsiella
Neisseria
Serratia

201
Q

Ciprofoxacin used against

A

Second generation quinolone
Inhibit topoisomerase II

Legionella
Pseudomonas

202
Q

Vancomycin use against

A

MRSA (s. aureus)

Clostridium difficile

203
Q 
Fever 
Body aches
Generalized weakness
Rash on legs
Abdominal pain and weight loss
Decreased sensation in leftfoot
Edema
Biopsy: necrotizing vasculitis without IgA deposition
c-ANCA and p-ANCA negative
Image: red dots all over legs

What is most likely associated with the vasculitis?

A. Hepatitis B seropositivity
B. History of heavy smoking
C. Jaw claudication
D. Recent upper respiratory infection
E. Weak pulses in upper extremities
A

A. Hepatitis B seropositivity

Patient has polyarteritis nodosa (PAN)

Vasculitis of medium vessels
Spares lungs
Palpable purpura
Assoc w/ Hep B
Necrotizing inflammatory lesions
HTN
Asymmetric polyneuropathy
Skin lesions
GI
204
Q

+ p-ANCA
Lungs
Kidneys
Nasophagyngeal

A

Microscopic polyangitis

205
Q

Amaurosis fugax

A

Acute painless onset of monoocular visual loss with normal funduscopic examination

With background of atherosclerosis

Transient retinal ischemia originating from atherosclerotic carotid artery disease

Ischemia from hypoperfusion of optic nerve or retina

206
Q

V1, V2, V3 elevations what artery associated

A

Left anterior descending artery

207
Q

5 y.o low grade fever and rash
Bright red erythemaous rash on face prominent on cheeks
Blanching reticulated rash on arms and trunk. Up to date on vaccinations. Facial rash erupted 3 days ago and body rash this morning. Reticulocytopenia

A. Coxsackievirus A
B. Human herpesvirus 6
C. Measles
D. Parvovirus B19
E. Streptococcus pyogenes
A

D. Parvovirus B19

Fifth’s disease
Erythema infectiosum

Slapped cheek

  • respiratory droplets
  • bone marrow suppression
208
Q

Hand foot and mouth disease

A

Coxsackievirus type A

  • nonenveloped
  • linear ssRNA virus
  • fecal oral or contact
  • summer to early fall
209
Q

Herpesvirus type 6

A

Roseola infantum
- enveloped linear ds DNA virus

High fever
Macular rash over body

9-12 months
High fever 3-5 days
Rash after fever

210
Q

Streptococcus pyogenes

- rash

A

Scarlet fever

Fever
Exudative pharyngitis
Scarlatiniform rash

Fever and sore throat

Sand-paper rash
Strawberry tongue 1-2 days following sore throat

Rash begins in groin and armpits

Delayed type skin reactivity to pyrogenic exotoxins

211
Q

Hyperacusis

A

Increased sensitivity to certain frequencies and volume ranges of sound

Decreased tolerance to sounds

Lesion of facial nerve

212
Q

1) Spinothalamic tract conveys

2) Lateral corticospinal tract

A

1) Pain
Temp
Crude touch

2) Primary motor

3)

213
Q

Brain is from what embryonic layer

A

Ectoderm

- Neural tube

214
Q

Bone tumor

1) Anaplastic stromal cells make a tumor osteoid bone matrix
2) Epitheloid clusters with vesicular nuclei and abundant vacuolated soap bubble like cytoplasm
3) Sheets of oval/spindle cell with interspersed large multinuclearted ostoclast like giant cells
4) Small round cells some of which are binucleated with abundant cartilage like matrix

A

1) Osteosarcoma
2) Chordomas
3) Giant cell tumor
4) Chondrosarcoma

215
Q

Cardiogenic shock

A. High cardiac output
B. Hyperkalemic hyponatremic metabolic acidosis
C. Inadequate ventricular function
D. Low cardiac filling pressures
E. Low pulmonary wedge pressure
A

C. Inadequate ventricular function

Shock

  • Low blood pressure
  • Hypoperfusion
  • Adequate blood volume

Inability of heart to generate flow thorughout the body due to myocardial infarction

Unable to maintain oxygenation of its tissues

A. High cardiac output
- Septic shock early presentation

B. Hyperkalemic hyponatremic metabolic acidosis
- adrenal shock secondary to addisonian crisis

D. Low cardiac filling pressure
- opposite in shock, have high cardiac filling pressures due to failure of cardiac output to match venous return

E. Wedge pressure= left atrial pressure is elevated in shock

216
Q

Case control

A

Know outcome looking for risk factors

Odds ratio

217
Q

Odds ratio is for

A

Case control

Not cohort studies

218
Q

Measured in cohort studies

A

relative risk

219
Q

Extrinsic eye muscles

  • Innervation
  • fxn
A

1) Superior rectus muscle
- Oculomotor (III)
- Moves gaze up and in

2) Medial rectus muscle
- Oculomotor (III)
- Adducts eye

3) Lateral rectus muscle
- Abducens muscle (VI)
- Abducts eye

4) Inferior rectus muscle
- Oculomotor (III)
- Move gaze down and in

5) Superior oblique
- Trochlear (IV)
- abducts, depress, IR

6) Inferior oblique
- Oculomotor (III)
- Up and out, adduct

220
Q

Diplopia when looks down what extraocular muscle

A

Superior oblique

- trochlear nerve

221
Q

What channels blood to muscles during exercise

A

Metabolites

  • CO2, H, K, Adenosine
  • decreased O2

Dilates arteroles locally

222
Q

Describes what

1) 2 micron spherical micro-organism in the brush border
2) 4-6 micron single cell organisms in the lumen near teh absorptive surface
3) Macrophages in the lamina propria bearing PAS positive bacteria
4) Superficial penertrating ulcers with a mixed inflammatory infiltrate perhaps containing non-caseating granulomas

A

1) Cryptosporidia
- malabsorption in immunocompromised

2) Giardiasis
- prevent absorption of nutrients
- nausea
- purple burps
- belching sulfurous taste
Ghost face on stain (ghost balloon)

3) whipple disease
4) crohns disease

223
Q

Boerhaave syndrome

A

excruciating retrosternal chest pain due to intrathoracic esophageal perforation after vomiting

224
Q

Female altered mental status and convulsions. Took unknown amount of medication to commit suicide.

Tachycardia
Fever
Large pupils with slow reactivity
Gag reflex minimal
No response to auditory stimuli
Withdraws from pain
Widened QRS complex
A. Alprazolam
B. Amitriptyline
C. Amlodipine
D. Fluoxetine
E. Sertraline
A

B. Amitriptyline

TCA

  • Cardiotoxicity
  • Convulsions
  • antiCholinergic
225
Q

Barretts esophagus is what

A

Columnar metaplasia replacing normal squamous epithelium; esophageal adenocarcinoma

226
Q

CTG trinucleotide in a serine-threonine kinase

caused by

A

Myotonic dystrophy type I (DM1)

Instability during maternal meiosis

227
Q

Instability during both maternal and paternal meiosis

A

Friedreich ataxia
- AR
GAA repeat

Limb and gait ataxia
Cardiomyopathy
DM

228
Q

Instability during paternal meiosis

A

Huntington disease

CAG repeat

229
Q

BRCA mutation affects what gene repair

A

Homologous recombination

230
Q

Intrauterine adhesions what is seen in tissue biopsy

A

Absent stratum basalis in an endometrial biopsy

231
Q

Uncontrollable facial and chest flushing
Diarrhea
Wheezing
Elevated 5-HIAA

Tx
Can led to
Additonal finding

A

Carcinoid syndrome
- secretion of serotonin

Octreotide

Niacin deficiency

Tricuspid regurgitation

232
Q

Arterial blood gas volumes on COPD patient

pH
Oxygen tension
Carbon dioxide tension
Oxyhemoglobin saturation

A

Decreased pH
Decreased oxygen tension
Increased carbon dioxide tension
Decreased oxyhemoglobin

Patient has chronic bronchitis

  • Airway resistance increased due to dynamic airway compression
  • Leads to air trapping

Retention of carbon dioxide (hypercapnia)
Respiratory acidosis
Reduced alveolar ventilation –> decreased partial pressure of O2 –> decreased oxygen tension and decreased oxyhemoglobin saturation

233
Q

Metformin
Atorvastatin
Lisinopril

Drug taht prevents progression of kidney disease inhibits an enzyme found where

A

Lisinopril

- inhibits ACE which is found in the lung

234
Q

Diabetic nephropathy on renal biopsy

A

Uniform glomerular basement membrane thickening

235
Q

RUQ pain
Nausea
Loss of appetite
Fever fatigue

Drank water in mexico

Dark urine and pale stools

Negative for E.colli and H2S enterobacteriaceae

ALT and AST elevated
Alk Phos elevated

Most likely due to?

A

Hepatitis A virus

2-6 weeks incubation

Not Ecoli 
Not salmonella (H2S positive)
236
Q

Patient traveled to Congo. Altered mental status, fever, chills, headache. Nausea and vomiting.

Diffuse erythematous nonpruritic maculopapular rash on trunk. Petechiae on arms and hands. Positive fecal occult blood test. Bleeding from intravenous line.

Elevated D-dimer
Low Fibrinogen
Elevated PTT
Elevated PT and INR
Low platelets

Condition?
Treatment

A

Ebola causing DIC

Quarantine and fresh frozen plasma

237
Q

16 AA with sickle cell disease. Has malar rash, extreme fatigue and weakness. Two days prior, temp, nasal congestion, HA and dry cough. Mom had same presentation 2 weeks earlier without rash, followed by arthralgia of wrist and knees

Low Hemoglobin
Low hematocrit
Low reticulocytes

A

Aplastic crisis due to parvovirus B19

Evident by decreased hemoglobin and hematocrit and decrease in reticulocyte count.

Slap Cheek “Fifths disease”

Malar rash seen with children

Adults will get arthralgias of knee and wrist

Self-limiting and transient bone marrow suppression in healthy individuals

238
Q

Heart issue seen in alcoholics

A

Dilated cardiomyopathy

Shows left and right heart failure
S3 heart sound
Systolic impairment

Dilated ventricles have fibrotic non-contractile tissue replacing their myocardium –> weak contractions of left ventricle

239
Q

Disorganized hypertrophic myocardial fibers with

A

hypertrophic cardiomyopathy (HCM).

LV hypertrophy
Obstruction of LV outflow
Diastolic dysfunction

240
Q

1) Microcytic hypochromic RBC with coarse basophilic stippling
2) Microcytic hypochromic RBC with elongation

A

1) Beta-thalassemia

2) Iron deficiency anemia

241
Q

Basophilic stippling

A

Lead poisoning

242
Q

65 y.o man with diarrhea and steatorrhea for 2 weeks associated with intermittent diffuse abdominal pain and cramping. Joint pain for 6 months. Negative for RA. Murphy negative. HIV negative.

A

Whipple disease

Diarrhea
Steatorrhea
Malabsorption
Joint pain

PAS stain
Gram positive bacillus

243
Q

IBS characteristics

A

Recurrent abdominal pain on average 1 day per week in last 3 months related to defecation and associated with changes in stool frequency and form (appearance)

244
Q

21 y.o rash 1 week. Red ring with central clearing. Single ring initially spread over back. Pruritic. Fine scaling pink oval papules scattered along the lines of skin folds, heavier distribution along lower aspect of back. Face palms and soles spared.

A. Drug reaction
B. Erythema migrans
C. Pityriasis rosea
D. Secondary syphilis
E. Tinea corporis
A

C. Pityriasis rosea

Key: Scattered along lines of skin folds

Herald rash
Christmas tree

Initial oval 5 cm plaque scaly
Secondary eruption in tree like pattern

Supportive tx

245
Q

25 y.o with major depression. Found with empty bottle of medication. Agitated and confused. Emesis, diarrhea. Fever, high blood pressure

Anxious, restless
Oriented to self only
Diaphroetic
Mydriasis
Upper DTR 3+
Lower DTR 4+ with myoclonus
Tremor
No rigidity
Sinus tachycardia
Increased creatine phospholkinase
A. Hypertensive crisis
B. Malignant hyperthermia
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
E. Tricyclic antidepressant overdose
A

D. Serotonin syndrome

Cognitive impairments
Autonomic instability
Somatic effects
Hyperreflexia **

246
Q

Hypertensive crisis

A 
Severe HTN
End organ symptoms
Tachycardia
Cardia arrthymias
Stroke

Too much monoamine oxidase inhibitors
or taken with drugs that potentiate catecholamine activity or tyramine (wine cheese)

247
Q

Malignant hyperthermia

A

Inherited genetic mutation of the ryanodine calcium channel receptor responsible for Ca release within SR of skeletal muscle

When exposed to anesthetic agents during surgery –> prolonged muscle contraction

Tachycardia
Tachypnea
Hyperthermia
Acidosis
Muscle rigidity
Rhabdomyolysis
248
Q

Neuroleptic malignant syndrome

A

Adverse drug rxn to antipsychotic

Increased dopamine blockade throughout body

Autonomic instability
Muscle rigidity
high fever
Decreased reflexes

"FEVER"
Fever
Encephalopathy
Vital signs unstable
Elevated creatine phosphokinase
Rigidity of muscle
249
Q

TCA overdose

A

Dry mouth
Constipation
Urinary retention

Fatal arrhythmia

Tachycardia

250
Q

Hand foot and mouth

  • virus
  • description of virus
A

Coxsackie A virus

Naked icosahedral capsid, single stranded RNA

Positive sense (+)

251
Q

Food stuck in throat
Iron deficiency anemia

At risk for what cancer

A

Plummer vision syndrome

Esophageal webs
Iron deficiency anemia
Dysphagia

Esophageal squamous cell carcinoma

252
Q

Sleep walking

A

CNS immaturity

Normal

TCA (imiprmine), benzo, SSRI if continued or injury high risk

253
Q

What would increase MVP murmur

A

Valsalva maneuver

Decrease volume of left ventricle, causes the prolapse to occur sooner

254
Q

Increase preload maneuver

A

Squatting
Isometric handgrip

Aortic regurg louder

255
Q

Inspiration on heart murmur

A

increase right heart sounds

256
Q

Hand grip

A

Increase afterload

Increase intensity MR, AR, VSD
Decrease hypertrophic cardiomyopathy and AS murmurs

257
Q

Valsalva

A

Decrease preload

Decrease intensity of most murmurs

Increase hypertrophic cardiomyopathy

MVP earlier onset

258
Q

Rapid squatting

A

Increase venous return
Increase preload
Incerase afterload

Decrease intensity of hypertrophy cardiomyopathy

Increase MR, AR, and VSD murmur

MVP later onset

259
Q

Cirrhosis on liver

  • Alcohol
  • Autoimmune
A

causes nodules in the lobules

Alcohol
- uniform small nodules (micronodular) hepatic fibrosis

Autoimmune
- lymphocytes, large nodules hepatic fibrosis

260
Q

Triangular space

Quadrangular space

Triangular interval

A

1) Triangular space
- Circumflex scapular artery

2) Quadrangular space
- Axillary n.
- Posterior circumflex humeral artery.

3) Triangular interval
- deep brachial artery
- radial nerve

261
Q

VHL syndrome

A

AD

Multiple tumors including hemangioblastomas, RCC, pheochromocytomas

262
Q

Uses

1) Amphotericin B
2) Ivermectin/ thiabendazole
3) Metronidazole

A

1) Severe systemic fungal infections
2) nematode infection, strongyloides stercoralis
3) Anti-protozoan drug, and anaerobic bacteria (not fungal infections)

263
Q

28 y.o episodes of weakness and paresthesia over past few years. Trouble walking and falls easily. Can not make it to the bathroom to urinate in time. Blurry vision. Symptoms come and go. Last few days to weeks. Symptoms free for months.

Imaging?

A

MS

Periventricular plaques on MRI

264
Q

Enlarged bilateral cystic ovaries in obese infertile female

due to
lab values
associated with

A

Polycystic ovarian syndrome

Increased LH production and slightly decreased FSH

Abnormal fxn of HPO axis
Deranged steroid synthesis by theca cells

Increased LH
Decreased FSH
Increased testosterone
Increased androgens
Increased estrogen

Insulin resistance type 2 DM

265
Q

Infectious colitis

A

Common cause of acute diarrhea by infectious etiologies including viruses (norovirus, rotavirus, adenovirus), bacteria (salmonella, shigella, e.coli, c. diff) and protozoa (cryptoporidium, girdia, entamoeba)

Self limiting

266
Q

Associated with obstructive sleep apnea

A. Cataplexy
B. Cheyne-Stokes respirations
C. Hallucination while falling asleep
D. Increased sleep latency
E. Pulmonary hypertension
A

E. Pulmonary hypertension

267
Q

Cheyne-Stokes respiration

A

Pattern of cyclic bradypnea followed by apnea and then hyperventilation.

Central sleep apnea

Dysfunctional respiratory drive resulting from lesion in the central nervous system respiratory centers

Assoc w/ strokes, brain injuries, brain tumors and other CNS insults.

268
Q

Patient experiences rapid eye movements. This stage of sleep is associated with

A. a rise in acetylcholine
B. an increase in muscle tone
C. slow and high amplitude EEG waves
D. High dopamine levels
E. High melatonin levels
A

A. a rise in acetylcholine

REM sleep

269
Q

Slowest and highest amplitude waves on EEG

A

Delta brain waves

non-REM stage 3

270
Q

3 y.o SOB with changes in facial skin color when crying or running. Has to squat to catch her breath. Systolic crescendo-descrscendo murmur in left upper border. Upturned cardiac apex

A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media

A

C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation

Tetralogy of Fallot

271
Q

16 y.o sports physical, blowing pansystolic murmur over left middle and lower sternal border.

A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media

A

B. Isolated malformation of the interventricular septum

VSD

272
Q

24 y.o uncontrolled HTN. Short stature. Elevated blood pressure in upper limbs. Increased caprefill in lower extremities. Cramping in calves and cold feet

A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media

A

E. Thickened aortic wall media

Turner syndrome

Coarctation of aorta

273
Q

4 month old, regular examination. Tires quickly with nursing. Persistent flow murmur throughout systole and diastole

A. Malformation of the interatrial septum
B. Isolated malformation of the interventricular septum
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation
D. Shunt between aorta and pulmonary artery
E. Thickened aortic wall media

A

D. Shunt between aorta and pulmonary artery

PDA

Machine like murmur

274
Q

24 y.o with pelvic pain 3 days. burning sensation when urinating, 2 days ago notice vaginal discharge. 101 temp. Elevated white blood count 80% neutrophils. Pelvic exam displays cervical motion tenderness and thin, mucopurulent discharge.

Thayer-Martin agar fail
NAAT successful

A. Catalase-negative, gram positive cocci
B. Coagulate-positive, gram positive cocci
C. Gram negative diplococci
D. Lactose-positive, gram-negative rod
E. Non-gram staining bacteria

A

E. Non-gram staining bacteria

Chlamydia trachomatis

  • lacks cell wall
  • gram negative like

NAATs**

275
Q

Thayer-Martin

A

Gonorrhea

276
Q

Tx Chlamydia

A

Doxycycline

Azithromycin

277
Q

Used to tx? STI

1) 5-flurouracil
2) Acyclovir
3) Metronidazole
4) Penicillin

A

1) HPV
2) HSV
3) Gardnerella vaginalis
4) Syphilis (trepponema pallidum)

278
Q

Organism that requires similar environmental conditions for growth and production as chlamydia trachomatis

A

Rickettsia prowazekii

Obligate intracellular bacteria

279
Q

Type of organism environment

1) E.coli
2) Listeria monocytogenes
3) Pasteurella multocida
4) Staphylococcus species

A

1) Facultative anaerobe
2) Facultative intracellular anaerobe
3) Facultative anaerobe
4) Facultative anaerobes

280
Q

cecum location

A

right lower corner right before ascending colon

281
Q

Topiramate on other medication

A

CYP3A4 inducer

Increases metabolism of hormones

282
Q

Measles type of virus

A

Paramyxoviridae virus

283
Q

Picronaviridae

A

Coxsackievirus

284
Q

Togaviridae virus

A

Rubella

285
Q

ss linear RNA virus with icosahedral capsid

A. Bunyavirus
B. Orthomyxovirus
C. Picornavirus
D. Polyomyavirus
E. Reovirus
A

C. Picornavirus

286
Q

Description

1) Bunyavirus
2) Orthomyxovirus
3) Picornavirus
4) Polyomyavirus
5) Reovirus

A

1) Bunyavirus
- enveloped
- ss negative sense circular RNA
- helical capsule

2) Orthomyxovirus
- enveloped
- ss, negative sense, linear RNA virus
- helical capsule

3) Picornavirus
- ss linear RNA virus
- icosahedral capsid

4) Polyomyavirus
- ds circular DNA virus

5) Reovirus
- ds linear RNA virus
- icosahedral capsid

287
Q 
Turkish Mediterranean descent
Mouth and genital ulcers
No sexual history
Uveitis
Erythema nodosum

What is it
Associated with

A

Behcet syndrome

Immune complex vasculitis

Associated iwth HLA-B51

288
Q

Nucleoside reverse transcriptase inhibitor (NRTI)

A. Acyclovir
B. Efavirenz
C. Nelfinavir
D. Saquinavir
E. Zidovudine
A

E. Zidovudine

Acyclovir

  • Guanosine analog
  • HSV tx

Efavirenz
- non-nucleoside reverse transcriptase inhibitor

Nelfinavir and saquinavir: protease inhibitors

289
Q

Alcoholic with swelling in extremities. Shifting dullness to percussion. Periumbilical vessels. Tender nodules at 5th intercostal space. Mechanism of edema?

A. Decreased plasma colloid oncotic pressure
B. Increased capillary hydrostatic pressure
C. Increased interstitial colloid oncotic pressure
D. Increased interstitial glycosaminoglycans accumulation
E. Increased permeability of the capillary walls

A

A. Decreased plasma colloid oncotic pressure

Cirrhosis of liver

Decreased production of albumin

290
Q

Meissner

Ruffini

Merkel

Pacinian

A

Meissner

  • superficial
  • fine/ light touch

Ruffini

  • superficial
  • pressure, finger tips

Merkel

  • Deep
  • Pressure, deep static touch

Pacinian

  • Deep
  • Vibration and pressure
291
Q

16 y.o with mild scleral icterus without jaundice. Elevated direct and total bilirubin. Elevated urinary coproporphyrin I.

Due to

A

Rotor syndrome

Altered ability to transport bilirubin glucuronides into bile canaliculi

292
Q

Esophageal varices due to what vessels

A

Left gastric

Azygos

293
Q

Periumbilical varices due to what vessels

A

Superficial epigastric

Branches of paraumbilical veins

294
Q

Rectal varices due to what vessels

A

Superior rectal vein with the middle and inferior rectal veins

295
Q 
Alcoholic in ER
Weakness, dizzinuess
Numbness in both lower extremities
Malnourished
Homeless
Bilateral rotatry nystagmus
Angular cheilitis

Microcytic hypochromic red cells with coarse basophilic granules

A

Vitamin B6 deficiency

Sideroblastic anemia
Numbness of extremities
Glossitis
Cheilosis

296
Q

Bullet that is necrosis

A

Gas gangrene

Clostridium perfringens

Gram positive spore forming obligate anaerobic bacillus.

Produce alpha toxin
- a phospholipase that degrades tissue and cell membranes

297
Q

Organism?

1) Cleaving SNARE protein required for neurotransmitter release
2) Inactivation of the 60S ribosome by cleaving rRNA
3) Inactivation of mitogen-activated protein kinase kinases

A

1) Clostridium tetani

2) Shigella species
- dysentery due to shiga toxin
- shiga toxin works by inactivating 60S ribosome through cleaving rRNA

3) Bacillus anthracis
- black eschar
- Protective factor and lethal factor combine on surface they form lethal toxin
- Lethal toxin is a Zn-dependent endoprotease that clips off the N-terminus of mitogen-activated protein kinase kinases (MAPKK)

298
Q

Paget disease of breast biopsy

A

Large, atypical cell with clear halos within the epidermis

299
Q

Nodular proliferation of cells extending from the stratum basalis

A

Basal cell carcinoma

300
Q

Stromal overgrowth with compressed glandular structures

A

Phyllodes tumor
- fibroepithelial stroma of teh breast

Multinodular firm and painless masses

301
Q

Latent infection
Capitans wheel
Fungal
Central america

A

Paracoccidioidomycosis brasiliensis

302
Q

Diarrhea

1) Motile trophozoites on microscopy
2) Genome identified by reverse transcriptase PCR
3) growth at 42 C (107.6 F)
4) Growth on thiosulphase citrate bile salt sucrose agar
5) Lactose fermentation on MacConkey agar

A

1) Giardia lamblia
2) Norovirus
3) Campylobacter jejuni
4) Vibrio cholerae
5) E. Coli

303
Q

Lab findings with CLL

Associated anemia

A

Elevated LDH
Elevated beta-2 microglobulin

Autoimmune hemolytic anemia
- Spherocytes

304
Q

Lung maturity when

A

36 weeks

305
Q

Camping trip
HIV male
Watery diarrhea, nausea foul smelling flatulence

Acid fast stain negative
Iodine stain reveals oval cysts

A. Cryptococcus neoformans
B. Cryptosporidium parvum
C. Entamoeba histolytica
D. Giardia lamblia
e. Isospora belli
A

D. Giardia lamblia

Motile trophozoites or oval cysts

306
Q

Cryptococcus neoforms

A

encapsulated yeast

Meningococcal manifestation in AIDs patients

307
Q

Cryptosporidium parvum

A

chronic watery diarrhea in IC patients

AIDs associated diarrhea

Positive for acid fast stain

308
Q

Tx Giardia lamblia

A

Metronidazole

Assoc disulfram like rxn

309
Q

Metronidazole

A

GET GAP on the Metro

Giardia
Entameoba
Trichomonas
Gardnerella
Anaerobes (clostridium, bacteroids, actinomyces)
h. Pylori
310
Q 
8 y.o 
Not vaccinated
Stiff neck
Trouble swallowing water
Jaw hurting
Hypertonicity of masseter muscles

After playing in old tree house

A. Acid fast positive aerobic, rod
B. Gram positive catalase negative cocci
C. Gram positive coagulase positive cocci
D. Gram positive obligate aerobic coccobacilli
E. Gram positive spore forming rod

A

E. Gram positive spore forming rod

Clostridium tetani

311
Q

Clostridium tetani exotoxin MOA

A

Decreased release of inhibitory neurotransmitters GABA adn glycine

312
Q

Pain and temperature sensations from the body are transmitted to the ventral posterolateral nucleus of thalamus by which pathway

A. Lateral corticospinal tract
B. Medial lemniscus
C. Reticulospinal tracts
D. Spinocerebellar tract
E. Spinothalamic tract
A

E. Spinothalamic tract

313
Q

Patient with MS and spasticity tx

A

Baclofen
(Agonist at the GABA-B receptor)

Tizanidine
(alpha 2 agonist)

314
Q

Alcoholic unconscious
Pulseless electrical activity
Necrosis of mammillary bodies and gray matter surrounding third and fourth ventricles

Brain findings associated with a decrease in?

A. G6PD
B. Glutathione reductase activity
C. Transketolase activity
D. Serum methylmalonic acid
E. Serum NADPH
A

C. Transketolase activity

Wernicke encephalopathy

Hemorrhage and necrosis in mammillary bodies and periaqueductal gray matter

Thiamine deficiency

  1. Pyruvate dehydrogenase (pyruvate –> acetyl-CoA)
  2. a-ketoglutarate dehydrogenase (citric acid cycle)
  3. branched chain a-ketoacid dehydrogenase
  4. Transketolase (pentose phosphate pathway, ribulose 5-P to glyceraldehyde 3 P
315
Q

Insulin uses which molecules for effect

A. Janus kinase (JAK)
B. Lipoxygenase
C. Phospholipase C
D. Protein kinase A
E. Protein phosphatase
A

E. Protein phosphatase

Receptor tyrosine kinase

  • MAP kinase
  • PI3K –> protein phosphatase
316
Q

JAK second messenger for

A

Growth hormone
Prolactin
IFN
IL-..

317
Q

Patient begins nasal cannular oxygen supplementation. Respiratory rate decreases shortly after beginning.

Caused by?

A

Carotid bodies

Supplemental oxygen administered rapid increase in PaO2 –> reduced peripheral chemoreceptor stimulation and decrease respiratory rate

318
Q

Carotid bodies vs central chemoreceptors

A

Central chemoreceptors

  • medulla
  • respiraotry response to hypercapnia (not hypoxemia)
  • CO2 readily diffuses through BBB
  • decreased pH detected

Carotid bodies

  • sense PaO2
  • stimulated by hypoxemia
319
Q

Parenternal nutrition and gall stones

A

Decreased cholecystokinin release due to lack of enteral stimulation

320
Q

Reverse methotrexate toxicity

A

Folinic acid

Leucovorin

321
Q

HIV associated nephropathy (3)

A

Hematuria
Hypertension
Edema

322
Q 
HIV started treatment
Edema
Fatigue
Elevated creatinine 
Decreased phosphorus
Proteinuria 
Glucosuria
Loss of brush border and basement membrane denudation
Intracytoplasmic eosinophilic inclusions
A

Tenofovir-induced nephrotoxicity

NRTI

Acute kidney injury (elevated creatinine, water retention)

Proximal tubule dysfunction ( phosphaturia, glucosuria, proteinuria)

Loss of brush border
Basement membrane denudation

Evidence of giant mitochondria (large eosinophilic inclusions)

323
Q

Sudden cardiac death in 20 y.o Mutation in protein belong to which structure

A

Sarcomere

  • beta myosin heavy chain
  • Myosin-binding protein C
324
Q

Results from mutations affecting proteins that make up desmosomes (plakoglobin, desmoplakin)

A

Arrhythmogenic right ventricular cardiomyopathy

325
Q

Metformin tx measure what ahead of time

A

creatinine level

renal insufficiency

326
Q

Male

Sclerotic bony metastases in lumbar spine

A

Prostate cancer

Osteolytic (lucent)
- osteoclast stimulation

Osteoblastic (sclerotic)
- osteoblast activity

327
Q

Angiogenesis is driven by

A

Blood vessel formation

Vascular endothelial growth factor (VEGF)

Fibroblast growth factor

328
Q

Epidermal growth factor (EGF) does waht

A

mitogenic influence of epithelial cells, hepatocytes and fibroblasts

329
Q

Artery associated with elevation in leads II, III, avf

A

Right coronary artery

330
Q

Tumor penetration of basement membrane uses which substances

A

Collagenases and hydrolases (Metalloproteinase)

331
Q

Pancreas of 22 y.o recurrent pulmonary infections and finger clubbing shows extensive exocrine gland atrophy and fibrosis. Pancreatic ducts are lined with squamous epithelium with areas of keratinization. Deficiency of?

A

Vitamin A

Cystic fibrosis
- deficiency of fat soluble vitamins (ADEK)

332
Q

Myelofibrosis

  • type of malignancy
  • clonal expansion of
  • secretion of
A

Hematopoietic stem cell malignancy

Megakaryocytes

TGF-beta secretion
- stimualtes fibroblasts to fill medullary space with collagen.

333
Q

Risk factors for diverticular disease

A

Diet high in red meat, fat and low in fiber

334
Q

Hip fracture. Damage to which artery causes osteonecrosis

A

Medial circumflex

335
Q

Metabolism of calories per gram

1) Protein and carbs
2) Fat

A

1) Protein and carbs
- 4 calories/ gram

2) Fat
- 9 calories/ gram

336
Q

Solid left adnexal mass
Ovarian mass is yellow and firm
Small cuboidal cells in sheet with glandular structures containing acidophilic material

Cells are arranged in microfollicular pattern around a pink eosinophilic center

A

Granulosa cell tumor
- secreting estrogen

Call-Exner bodies

337
Q

Duchenne muscular dystrophy mRNA change

A

Nonsense mutation

UCA –> [ UAA, UAG, UGA]

338
Q

Monoclonal Ab for CD20

A

Rituximab

339
Q

Infliximab

  • type
  • use
A

TNF-alpha monoclonal Ab

Rheumatoid arthritis
ankylosing spondylitis
Crohns

340
Q

Interleukin-2

  • MOA
  • use
A

Regulates activation and differentiation of T-cells to aid in tumor cell destruction

RCC
Melanoma

341
Q

Imatinib

  • MOA
  • Use
A

BCR/ ABL

CML

342
Q

Abciximab

  • MOA
  • Use
A

Monoclonal Ab againts platelet GP IIb/IIIa receptor

Block platelet aggregation

Acute coronary syndrome

343
Q

Gardnerella vaginalis vis Giardia lambila

A

Gardnerella vaginalis

  • Gram variable rod, anaerobic
  • Vaginal discharge
  • Fishy smell
  • Clue cells
  • Metronidzole or clindamycin

Giardia lambila

  • bloating, flatulence
  • foul smelling diarrhea
  • campers
  • motile trophozoites and ovoid cysts
  • Metronidazole
344
Q

Alcohol associated level of hepatic injury

Poor prognosis

A 
Alcohol steatosis (reversible)
Alcoholic hepatitis (reversible) 
Alcohol cirrhosis (irreversible)

Prolonged PT time

345
Q

Gamma glutamyl transferase level

A

High level more specific for biliary injury

346
Q

Decrease risk of bone fractures and breast cancer

A

Raloxifene

347
Q

Rifaximin

  • mOA
  • given in addition to
A

Antibiotic taht alters GI flora to decrease intestinal production and absorption of ammonia

Lactulose
- catabolized by intestinal bacterial flora to short chain fatty acids, lowering the pH and increasing conversion of ammonia to ammonium

348
Q

Celiac disease

  • Calcium
  • Phosphorus
  • PTH
A

Vitamin D deficiency

Deficiency calcium
Increase PTH
Decrease phosphorus

349
Q

60 y.o with lactose intolerance for 2 months

  • due to
  • decrease what
A

Secondary lactase deficiency
- inflammation/ infection

Injury at mucosal brush border

Fermentation of undigested lactose by gut bacteria leads to increase in production of short chain fatty acids –> acidify stool

Decrease in pH stool

350
Q

Neurologic regression
Hepatosplenomegaly
Diminished reflexes
Cherry red spot

A

Niemann Pick

- Spingomyelin

351
Q

Lung tissue microscopic examination: spherules packed with endospores

A

Coccidioides immitus

  • dimorphic fungus
  • central california, arizona, new mexico
352
Q

Pyelonephritis –> hypoxic and breathing issues

Due to?
Phases

A

Sepsis

Acute respiratory distress syndrome (ARDS)
- bilateral pulmonary infiltrates and hypoxemia in the absence of heart failure

Exudative phase

  • inflammatory cytokines
  • increased capillary permeability
  • leakage of protein-rich fluid in the alveolar space
  • hyaline membranes

Proliferative phase

  • one to two weeks later
  • collagen deposited adn scarring
  • edema reabsorbed

Fibrotic phase
- excessive collagen deposition leads to irreversible pulmonary fibrosis and pulmonary htn

353
Q

Pica

A

compulsie consumption of nonstaple food or non-nutritive substance for >= 1 month

354
Q

Total gastrectomy need to supplement

A

A water soluble vitamin

B12

355
Q

Midline posterior fossa mass

Sheets of primitive cells and mitotic figures

A

Medulloblastoma

356
Q

Impaired neuromuscular transmission

A

Myasthenia gravis

- autoantibodies to ACh receptors

357
Q

Lysing of blood cells when incubated in hypotonic saline with glycerol

A

Hereditary spherocytosis (HS)

358
Q

Rheumatoid arthritis affects what part of spine

A

Cervical

359
Q

SLE
Prolonged PTT
False positive rapid plasma reagin (RPR)

Greatest risk for

A. Esophageal dysmotility
B. Menorrhagia
C. Painful hemarthroses
D. Recurrent miscarriages
E.Sclerodactyly
F. Tabes dorsalis
A

D. Recurrent miscarriages

SLE
- antiphospholipid antibodies

Hypercoagulable state

360
Q

Influenza vaccine MOA

A

Inhibition of viral entry into cells

Inactivated versions
- neutralizing antibodies to hemagluttinin ag

361
Q

HIV patient
CD4 400
Fever chills productive cough

Organism?

A

Strep. pneumoniae

362
Q

Increases urea reabsorption in collecting tubules

A

Vasopressin (ADH)

363
Q

Systolic murmur along the left sternal border that decreases in intensity with hand grip

Left venticular mass
Left ventricular cavity size
Left ventricular ejection fraction
Left ventricular relaxation

A

Hypertrophic cardiomyopathy

Involves hypertrophy of interventricular septum and obstruct LV outflow

Mass: increased
Cavity size: small
Ejection fraction: preserved
Relaxation: impaired

364
Q

Patients with MG are extremely sensitive to what drug

A

Vecuronium
Rocuronium

Nondepolarizing agaents

365
Q

Progressive weakness and fatigue over last year. Loss of expression of mutation that codes for a protein found on basolateral surface of hepatocytes and enterocytes. Protein is known to interact with transferrin receptor

Greatest risk of developing?

A

Primary hemochromatosis
- mutation of HFE protein

Detects falsely low iron levels

Get iron accumulation

Enterocytes: increase apical expression of DMT1, increasing iron absorption

Hepatocytes: decreasing hepcidin synthsis, increased feroportin expression –> increased iron secretion

Iron excess –> bronze diabetes

At risk for hepatocellular carcinoma

366
Q

Erratic behavior
HIV CD4 of 30/ mm3

Demyelination

A

JC virus

  • no edema
  • latent infection
  • attack olgiodendrocytes

Produce progressive multifocal leukoencephalopathy

367
Q

Gout can be caused by

A

Increased urate production

  • myeloproliferative/ lymphoproliferative disorders (polycythemia vera)
  • tumor lysis syndrome
  • HGPPT deficiency

Decreased urate clearance

  • chronic kidney disease
  • thiazide/ loop diuretics
368
Q

Type 2 DM
Confusion lethargy
Hypoglycemia
Elevated C-protein

What drug was used

A

Medication that stimulates pancreatic insulin secretion independent of blood glucose levels

Sulfonylureas (glyburide)

369
Q

Epinephrine administered after pretreatment with Drug A cause increase in insulin.

Drug A blocks?

A

Alpha 2 adrenergic receptors

370
Q

Epinephrine with what receptors increase insulin secretion

A

Muscarinic M3 (Gq)
Glucagon (Gs/Gq)
Beta 2 adrenergic (Gs)
GLP-1 (Gs)

371
Q

Painless Testicular tumor
Elevated lactate dehydrogenase
Elevated alpha fetoprotein

A

Nonseminomatous germ cell tumor

  • embryonal carcinoma
  • yolk sac tumor
  • choriocarcinoma

hCG
AFP

372
Q

Li-Fraumeni syndrome

A

TP53

Sarcomas
Breast cancer
Brain tumors
Adrenocortical carcinoma
Leukemia

AD

373
Q

5 y.o sunburns easily. Skin becomes red and scaly with minimal sun exposure. Hyperpigmented skin. Few nevi on hands.

Defect of?

A

Xeroderma pigmentosum

  • AR
  • defective nucleotide excision repair of DNA dmaged by UV light
374
Q

Flutamide MOA

A

Impaired androgen receptor interaction

Competitive testosterone receptor inhibitor

375
Q

Leuprolide MOA

A

Long acting GnRH agonist

- decrease testicular leydig cell stimualtion

376
Q

Anastrozole MOA

A

Aromatase inhibitors

Decrease peripheral convertsion of androgens to estrogen

377
Q

Finasteride MOA

A

Decreases peripheral convertsion of testosterone to DHT by binding 5alpha reductase

378
Q

Shigella infects via what cell

A

microfold (M) cells at base of mucosal villi within a Peyers patch

379
Q

35 y.o female to clinic due to severe heart burn that is resistant to over the counter anti-acids. Scattered telangiectasias on the face, several ulcers at tips of fingers, small calcium deposit in soft tissues of hands and elbows. Processes most likely cause of this heart burn?

A. Abnormal location of gastroesophageal junction
B. Fibrous replacement of the muscularis in the lower esophagus
C. Increased gastric acid production
D. Increase in resting lower esophageal sphincter tone
E. Uncoordianted, simulataneous muscle contractions in the lower esophagus

A

B. Fibrous replacement of the muscularis in the lower esophagus

CREST syndrome

380
Q

latent infection in neuronal cell bodies

A

Ganglia

HSV

381
Q

Kidney stone given morphine sulfate for pain. Fifteen minutes later, develops diffuse itchy rash

MOA?

A

IgE INDependent mast cell degranulation

382
Q

Pompe disease deficiency of

A

acid alpha-glucosidase

383
Q

Concentrations of K along nephron

Bowman capsule
PCT
Ascending Loop of Henle
Collecting duct

A

Bowman capsule 100%

PCT 35%

LOH 10%

Collecting duct 110%

384
Q

Prion disease causes what in brain

A

sponge-like vacuolated neurons in gray matter

385
Q

Intranuclear inclusions in oligodendrocytes

A

Progressive multifocal leukocencephalopathy due to JC virus

386
Q

PTSD tx

A

SSRI

387
Q

Prevention for Group B strep infection

A

Intrapartum ampicillin

388
Q

Gas gangrene

A

Clostridium perfringens

Also causes transient watery diarrhea and abdominal discomfort

389
Q

Bone pain
Hearing impairment

Multinucleated cells with over 100 nuclei

-Factor essential for differentiation of cells

A

Paget’s disease of bone

RANK-L
Receptor activator of nuclear factor kappa-B ligand

390
Q

Mitral regurgitation

  • Afterload
  • Preload
  • Ejection fraction
A

Afterload: decrease
(regurg so low resistance)

Preload: increase
(LV end-diastolic volume)

EF: Increase
(decreased afterload –> increase EF)

391
Q

Polyp formation steps

A

1) Normal mucosa –> small adenomatous polyp (adenoma)
= APC mutation

2) Increase size of adenoma
= KRAS mutation

3) Malignant transformation, adenoma to carcinoma
= TP53 mutation

392
Q

Pretreatment for MPTP toxicity produced by MAO type B

A

Selegiline

393
Q

5 y.o, bites on inbetween toes. Stool shows smooth thin walled eggs.

Infection?
Complication

A

Hookworm

  • Necator americanus
  • Ancylostoma duodenale

Egg-containing human feces in soil
- skin direct contact with soil

Larvae to lungs, rupture, coughed up and swallowed. In small intestine, mature into adults and attach to GI mucosa and feed on uman blood by lacerating capillaries

Iron- deficiency anemia
Microcytic anemia

394
Q

Fever HA confusion
Allergic to penicillin

Antibiotic started
Low Erythrocytes
Low Platelets
Low Leukocytes

which antibiotic?

A. Chloramphenicol
B. Clindamycin
C. Gentamicin
D. Metronidazole
E. Vancomycin
A

A. Chloramphenicol

Aplastic anemia

  • Carbamazepine
  • Chloramphenicol
  • Sulfonamides
395
Q

42 y.o episodic SOB adn cough. FEV1 is 71%. Predominant eosinophils

Causea

A

Asthma

  • Animal dander
  • Dust mites and cockroaches
  • Pollens and molds
396
Q

Nondepolarizing block vs depolarizing block

A

Nondepolarizing block

  • vecuronium
  • Gradual decrease

Depolarizing block
- Succinylcholine
- phase I: constant but diminished
phase 2: gradual decrease

397
Q

Outcome Hep B virus

A 
Complete resolution (>95%)
Chronic hepatitis (with or without cirrhosis) 
Fulminant hepatitis with massive liver necrosis
398
Q

Brain natriuretic effect on kidney

A

Increases sodium excretion

Increase GFR

399
Q

Anterior nucleus of hypothalamus

Fxn
Lesion

A

Panting or sweating

Lesion= hyperthermia

400
Q

Dorsomedial nucleus of hypothalamus

Fxn
Lesion

A

Rage

Lesion= decreased aggression and feeding

401
Q

Lateral nucleus of hypothalamus

Fxn
Lesion

A

Increased feeding

Lesion= decreased feeding

402
Q

Supraoptic nucleus of hypothalamus

Fxn
Lesion

A

Increased blood volume, blood pressure and metabolism

Lesion= diabetes insipidus

403
Q

Ventromedial nucleus of hypothalamus

Fxn
Lesion

A

Decreased feeding

Lesion= increased feeding

404
Q

34 y.o male present with dull epigastric pain for several weeks, worse after meals. Progressively worsened and now is symptomatic despite ranitidine use. History of recurrent kidney stones. Family history of same symptoms. Bitemporal hemianopsia
Elevated Calcium level
Elevated PTH

Epigastric pain due to

A. Ab directed toward parietal cells
B. Decreased gastric motility
C. Gastrin overproduction leading to acid release
D. H. pylori infection
E. Inhibition of prostaglandin E2 synthesis

A

C.Gastrin overproduction leading to acid release

MEN1

Hyperparathyroidism
Bitemporal hemianopsia (pituitary adenoma)
Peptic ulcer disease (gastrinoma)

Abdominal pain due to gastrin-secreting gastrinoma which triggers acid release

405
Q

Otitis media organism

A

Streptococcus pneumoniae

Strain not in vaccine

H. influenza type b less common since vaccination (Hib)
- Non typeable remains major cause of AOM in children

406
Q

Unilateral painless testicular enlargement. Bilateral gynecomastia. Elevated serum beta human chorionic gonadotropin level.

A. Choriocarcinoma
B. Diffuse large B cell lymphoma
C. Leydig cell tumor
D. Sertoli cell tumor
E. Yolk sac tumor
A

A. Choriocarcinoma

hCG has an analogue similar to LH –> precocious puberty, gynecomastia, impotence or loss of libido

Leydig

  • increased testosterone
  • Virulization and gynecomastia

Sertoli

  • androgens or estrogens
  • not enough to cause endocrinologic changes

Yolk Sac tumor

  • infants and children
  • painless bulky testicular mass
  • Alpha-fetoprotein
407
Q

Leydig cell tumor

  • secretion
  • causes
  • description
  • feature associated with
  • Marker
  • histology

Sertoli cell tumor

  • secretion
  • causes
  • description
  • histology
  • feature associated with
  • marker

Yolk Sac tumor

  • affects who
  • description
  • pattern
  • histology
  • feature associated with and description of
  • marker
A

Leydig

  • increased testosterone
  • Virulization and gynecomastia
  • yellow tan color
  • solid lobulated
  • Reinke crystals
  • Inhibin A
  • round nuclei, single prominent nucleoli and abundant eosinophilic cytoplasm or clear cytoplasm

Sertoli

  • androgens or estrogens
  • not enough to cause endocrinologic changes
  • well circumscribed, pale yellow to whitish gray
  • tall polyhedral cells arranged in nests, sheets and cords resembling spermatic tubules
  • perinuclear aggregates of intermediate filaments
  • Inhibin A marker
Yolk Sac tumor
- infants and children
- painless bulky testicular mass
-honey comb pattern
- reticular network is formed by vacuolated cytoplasm of tumor cells
-Schiller-Duvall bodies
(Central vessel rimmed by fibrous tissue and surrounded by malignant epithelial cells in a cystic space
- Alpha-fetoprotein
408
Q

First line A-fib

A

Dofetilide
Class III antiarrhythmic

Blocks K channels

409
Q

First line tx SVT

A

Adenosine

410
Q

Sarcoidosis causes elevated level of

CXR

A

ACE

ACE is produced by the granulomas in sarcoidosis

Enlarged hilar lymph nodes and bilateral pulmonary reticular opacities

411
Q

Ramelteon MOA

A

Positive actions on the suprachiasmatic nucleus

Selective melatonin receptor AGONIST
- binds MT1 and MT2 in suprachiasmatic nucleus

412
Q

29 y.o recurrent epistaxis. Frequent nose bleeds now anemic. Father same symptoms with GI bleeding.

Decreased hemoglobin
Positive hemoccult

A

Osler- Weber Rendu

  • hereditary hemorrhagic telangiectasia
  • AD

Dilated blood vessels

413
Q

Achalasia

- loss of

A

Loss of myenteric plexus

Loss of nitric oxide synthease producing neurons

414
Q

Was in water in Africa
Rapidly decreasing vision

A. Behcet
B. Kala-azar
C. Loiasis
D. Onchocerciasis
E. Sarcoidosis
Transmission?
A. Black fly
B. Deer fly
C. Idiopathic
D. Sand fly
E. Tsetse fly
Treatment?
A. Diethylcarbamazine
B. Ivermectin
C. Nifurtimox
D. Prednisolone
E. Sodium stibogluconate
A

D. Onchocerciasis

Onchocerca volvulus

  • parasite
  • black fly

Parasitic larvae into blood stream with bite

Ivermectin

415
Q

Oral ulcers
Genital ulcers
Eye redness and pain

A

Behcet syndrome

Turkish descent

Immune complex vasculitis

416
Q

Spiking fevers
hepatosplenomegaly
Pancrytopenia

  • Disease
  • organism
  • transmitted
  • tx
A

Kala-azar
aka visceral leishmaniasis

Caused by parasite Leishmania donovani

Sand fly
India

Sodium stibogluconate

417
Q

Worms seen in eyes (conjunctiva)
Swelling of skin

  • Disease
  • organism
  • transmitted
  • tx
A

Loiasis

Parasite Loa Loa

Chrysops flies
(Deer fly, horse fly, mango fly)

Tx: Diethylcarbamazine

418
Q

Tsetse fly

A

Trypanosoma brucei gambiense adn T.b. rhodesiense

African sleeping sickness

419
Q

4 y.o runny nose and trouble breathing. High pitched noise everytime he breathes in. LAD. Hypertonic scalenes and sternocleidomastoid muscles. Temperature

  • Disease
  • Seen on radiograph
  • organism
A

Laryngotracheobronchitis
- aka croup

Bark like cough

Subglottic narrowing
“Steeple sign”

Parainfluenza virus type 1

  • Paramyxoviridae
  • enveloped helical nucleocapsid negative sense ssRNA virus
420
Q

MRI of child’s brain reveals enamel-like calcifications and tumor that is located supratentorially

A. Containing foamy cells that are highly vascular
B. A remnant of Rathke’s pouch
C. Containing solid rosettes of small blue cells
D. Composed of Rosenthal fibers
E. Having a “Fried egg” appearance on histology

A

B. A remnant of Rathke’s pouch

Craniopharyngioma

Ectoderm

Supra cellar calcifications

421
Q

Brain tumor

1) Highly vascular foamy cells
2) Containing solid rosettes of small blue cells
3) Composed of Rosenthal fibers
4) Having a “fried egg” appearance on histology

A

1) Von Hippel-Lindau disease
2) Neuroblastoma

3) Rosenthal fibers are corkscrew-shaped intracytoplasmic inclusions that are seen in optic gliomas of neurofibromatosis 1 and pilocystic astrocytomas
- AD
- Cafe au lait
- visual disturbances

4) Oligodendrogliomas

422
Q

Infraorbital nerve

  • division of
  • does what
A

Terminal branch of maxillary division (V2) of trigeminal CN V

Sensory information from the lower eyelid, side of the nose and upper lip

423
Q

Tumor in proximal colon
Signet ring cells
Father and grandfather same presentation

A. Alternative splicing
B. Base excision repair
C. Mismatch repair
D. Nucleotide excision repair
E. Purine salvage
A

Lynch syndrome
- Hereditary nonpolyposis colorectal cancer

C. Mismatch repair

424
Q

Purine salvage defects

A

Lesch-Nyhan syndrome

  • deficency of HGPRT
  • self mutilation
  • hyperuricemia
  • mental retardation
425
Q

Side effect of diphenhydramine

A

Dry mouth

426
Q 
21 month old
Sick all the time
Oral thrush
RSV and influenza
Impetigo and exudative tonsillitis
A

Severe combined immunodefiviency

427
Q

Fasiculations in quadriceps muscles and tongue
Clonus of ankle reflexes
Dysarthria
Spasticity of elbow flexion

A. Anterior horn
B. Lateral horn
C. Posterior horn
D. Primary motor cortex
E. Reticular formation
A

A. Anterior horn

UMN

  • dysarthria
  • spasticity of elbow flexion
  • clonus of ankle reflexes

LMN

  • Fasciculation of tongue
  • Fasciculations in biceps muscles
428
Q

50 y.o man. Fatigue, fevers, joint and muscle pain and weight loss. Cough and dyspnea and occasional hemoptysis. Denies upper respiratory involvement. Peripheral sensory loss. Palpable purpura on skin and elevated erythrocyte sedimentary rate. Hematuria and mild proteinuira. Biopsy: vasculitis with an absence of granuloma formation.

Diagnosis
Marker
Tx

A

Microscopic polyangiitis (MPA)

Males 50 y.o

[Dont have chronic sinusitis seen in granulomatosis w/ polyangiitis]

Necrotizing vasculitis involving kidneys, lungs and skin with pauci-immune glomerulonephritis and palpable purpura

p-ANCA +
(anti-myeloperoxidase)

Tx Cyclophosphamide

429
Q 
Nausea, vomiting
Vertigo
Numbness on right side of face
Dysarthria and dysphagia
Uvula deviation to left
Hemianalgesia on right side of face and left side of body
Ataxia

Artery involved

A

Lateral medullary syndrome

RIght PICA

430
Q

Loss of pain and temp on face and body
Ipsl facial hemiparesis
Ipsilateral deafness
C/L body analgesia

A

Lateral pontine syndrome

AICA

431
Q

Contralateral hemianesthesia
C/L homonymous hemianopia
Ips horizontal gaze preference

A

MCA

432
Q 
Fever that rises and falls through day
Night sweats
Joint pain
Heart murmur
Mexico
Goat cheese and unpasteurized milk
A

Brucellosis

433
Q

Recurrent pyogenic infections
Oculocutaneous albinism
Progressive neurologic abnormalities
Coagulation defects

A

Chediak-Higashi syndrome
- AR

Abnormal lysosomal trafficking protein that results in defective phagolysosome formation

434
Q

Skin infection on leg. Red shiny and tender. Fever. Gram positive cocci, catalase negative, sensitive to bacitracin

Virulence factor?

A

Cellulitis

Streptococcus pyogenes

M protein

435
Q

Iron poisoning tx

A

Deferoxamine

436
Q

Lead poisoning tx

A

Dimercaprol
EDTA
Succimer

437
Q

Flumazenil

A

Antidote for benzodiazepine overdose

438
Q

Deferoxamine

A

Tx iron poisoning

439
Q

Type 2 diabetic
Sweating, dizziness, heart palpitations and tremor thirty minutes after taking meds. Appetite increased.

Diaphoresis
Tachycardia

A. Glucagon
B. Glyburide
C. Metformin
D. Propranolol
E. Rosiglitazone
A

Hypoglycemia

Second generation sulfonylureas

  • glyburide
  • glimepiride
  • glipizide
440
Q

Nephritic vs Nephrotic types

A 
Nephritic
[ HTN, Inc BUN/CR, Oliguria, RBC casts]
1) Post streptococcal glomerul
2) Rapidly progressive glomer
3) IgA nephropathy (berger)
4) Alport
5) Membranoproliferative glome
Nephrotic
[Proteinuria, edema]
1) Focal segmental glomeruloscl
2) Minimal change
3) Membranous nephropathy
4) Amyloidosis
5) Diabetic glomerulonephri

Nephritic/Nephrotic

  • Diffuse proliferative glomerulonephrtis
  • Membranoproliferative glomerulonephritis
441
Q 
14 y.o weight gain
Fatigue
Swelling in ankles and feet
Dark foamy urine
Hematuria and proteinuria

Proliferation of mesangial and endothelial cells of the glomeruli and expansion of the mesangial matrix along with immune deposits

A

Membranoproliferative glomerulonephritis

Hematuria and proteinuria
Edema

442
Q 
Edema
Foamy urination
Proteinuria
Low hematuria
Biopsy: diffuse thickening of walls of the glomerular capillaries
A

Membranous glomerulonephritis

443
Q

Temporal vs parietal radiation visual defect

A

Temporal
-upper right quadrant

Parietal
- Lower left quadrant

444
Q 
Fever Rash
Dysuria
Urinary urgency
Hematuria, mild proteinuria
WBC (eosinophils) in urine
Azotemia
Costovertebral angle tenderness

Diagnosis
Caused by

A

Acute interstitial nephritis

Drug induced

5 P's
Pee (diuretics)
Pain-free (NSAIDs)
Penicillins and cephalosporins
Proton pump inhibitors
RifamPin
445
Q

Polyribosylribitol phosphate (PRP)

A

Makes polysaccaride capsule

446
Q

Eosinophilic cell

A

Bright pink cell

447
Q

Hep B vs Hep C

Nephrotic disease

A

Hep B
Membranous GN > Membranoproliferative GN

Hep C
Membranoproliferative GN > Membranous GN

AM- STEP1 (20 decks)

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