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Things to know 3 Flashcards

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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
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
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
26
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
Inhalation of aerosols from an environmental source Legionella - Gram Neg rod that stains poorly
27
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
Trigeminal neuralgia Carbamazepine - Blocks Na channels
28
Tubular osmolarity Hypotonic, Isotonic or hypertonic in dehydrated patient. Compare nephron to serum 1) PCT 2) Macula Densa 3) Medullary Collecting Duct
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
29
Sunburst pattern | - Histology
Osteosarcoma Pleomorphic osteoid-producing cells
30
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
1) Ewing 2) Chondrosarcoma 3) Giant Cell Tumor - osteoclastoma 4) Multiple myeloma
31
Calcium infusion which will be increased? ``` A) 7- Dehydrocholesterol B) 1,25 Dihydroxycholecalciferol C) 24,25 Dihydroxycholecalciferol D) Previtamin D3 E) Vitamin D3 ```
C. 24,25 dihydroxycholecalciferol
32
Kidney spinal level Spleen level
Kidney T12- L3 Ribs 9 and 10
33
Spermatogenesis
"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
34
47 XXY male, one X chromosome from patients father error occurred at what stage of spermatogenesis?
Primary spermatocyte | - division of X and Y occurs at end of meiosis I
35
Spermiogenesis
Spermatid Haploid (1N, 1C ) --> Mature spermatozoon (1N, 1C) with acrosome, tail
36
47 XYY male, both Y from father, occur at what stage of spermatogenesis
Secondary spermatocyte
37
Lab findings on patient with polycystic kidney disease and elevated creatinine concentration 1. HCO3 2. PO4 3. PTH
Renal failure Increase PO4 Increase PTH Decrease HCO3
38
Patient with elevated 17-hydroxyprogesterone
21-hydroxylase deficiency
39
Barefoot on beach Cellulitis on lower extremity Blister formation Gram negative lactose fermenting organism
Vibrio vulnificus - swimming with brackish water - Shucking oysters Tx Tetracycline or 3rd generation cephalosporin
40
Endothelin-1
Stimulated myofibroblasts contraction
41
Thrombomodulin
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
42
Decreased gastric hydrogen chloride production Decreased mucosal thickness and hyperplasia of enterochromaffin-like cells. Resemebles what disease?
Chronic gastritis
43
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 ```
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
44
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
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
45
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. Expression of HOX gene normally expressed only caudal to C-7 Hox responsible for appendages
46
Vaginal pain with urination Bilateral vesiculoulcerative lesions of the introitus ``` Antimicrobial therapy? A. Acyclovir B. Amoxicillin/ clavulanate C. Ganciclovir D. Penicillin E. Vidarabine ```
HSV A. Acyclovir
47
Non-painful ulcerated indurated genital lesion
Syphilis Pencillin G
48
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
ITP A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
49
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) ITP C) Bernard-Soulier D) Glanzman thromboasthenia F) Von Willebrand def
50
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
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
51
Raynauds phenomenon avoid which drugs
Phenylephrine | - avoid alpha agonists
52
Blistering lesions in sun exposed areas. Recurrent hx of these lesions. Increased Total porphyrin Increase Urine uroporphyrin III Precursor to uroporphyrin?
Dx: Porphyria Precursor= Succinyl-CoA Defective uroporphyrinogen decarboxylase= porphyria cutanea tardia. Succinyl-CoA combines with glycine to form ALA start of heme synthesis
53
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?
Cryoglobulinemia secondary to hepatitis C Cryoglobulins in kidney cause nephrotic syndrome by settling in kidney Type III HS
54
``` 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 ```
C. Alpha-1,4- glucosidase Pompe disease
55
Necrosis of bacteria infections
Liquefactive Or brain infarct
56
Necrosis of TB or systemic fungi
Caseous necrosis
57
NE infusion. After 2 min coronary dilation ``` A) Adenosine B) Angiontensin II C) Epinephrine D) Histamine E) Thromboxane A2 ```
Adenosine Adenosine causes coronary dilation mediated by A2 receptors
58
Cecum metastasis to liver pathway
Ileocolic --> superior mesenteric --> portal --> right hepatic branch of portal
59
Vertical gaze palsy | Enlargement of third and lateral ventricles. Location of mass?
Pineal gland | - Pinealoma
60
Fever Large flaccid, Bullous lesions over trunk and abdomen Additional finding?
S. Aureus - Impetigo Positive nares culture for toxin producing S. aureus
61
Tx Malignant hyperthermia
Dantrolene Decreases Ca release from Sarcoplasmic reticulum
62
Antifungal which targets glucan expression on the fungal cell surface - type - use - adverse
Capsofungin Anidulafungin Micafungin (All Echinocandins) Inhibit cell wall synthesis by inhibiting synthesis of beta-glucan Tx: invasive aspergillosis, candida GI upset Flushing (histamine release)
63
Amphotericin B | - MOA
Binds ergosterol | - forms membrane pore that allows leakage of elecrtrolytes
64
Aspirin overdose pH PCo2 HCO3
Salicylates - cause increase anion gap metabolic acidosis with immediate hyperventilation as compensatory Decrease pH Decrease HCO3 Decrease PCO2 from hyperventilation
65
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 ```
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)
66
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 ```
D) Cyclosporine - Nephrotoxicity - HTN - Gingival hyperplasia - Hirsutism Azathioprine - Pancytopenia Cyclophosphamade - Hemorrhagic ycstitis - SIADH
67
CCK is released from
Enteroendocrine cells (I cells) found in upper small intestine (duodenum and jejunum)
68
Prolong QT due to decrease of what activity
Outward (delayed) rectify potassium channel | Not inward activating potassium channel
69
Vitamin from dairy
Vit D3
70
Organisms that cause microcytic anemia
Necator | Ancylostoma
71
Kidney with dilated ureter/ calyx in image
Tubular atrophy Small and nonfunctional kidnye
72
Man with PKD Elevated BUN/Cr pH? PCO2? HCO3?
Renal failure Metabolic acidosis - Decreased pH - Normal PCO2 - Decreased HCO3
73
Neonatal respiratory distress due to deficiency in
Dipalmitoylphosphatidylcholine Pulmonary surfactant composed of: lecithins (most important is dipalmitoylphosphatidylcholine)
74
Surfactant subtypes
A and D pulmonary host defense B and C reduce tension
75
Supplemented in chronic kidney disease
erythropoietin
76
Patient with Diabetes has diarrhea due to
Motility disorder
77
Bulimia values K HCO3 Anion Gap pH
Increase pH Increase HCO3 Decrease K Normal Anion gap
78
Diabetic ketoacidosis PCO2 HCO3 Anion Gap
Increased Anion gap Decrease HCO3 Decreased PCO2
79
Coccus in chains | Dental procedure
Viridians Streptococcus Partially green on blood agar Optochin resistant
80
What would cause ciprofloxacin for UTI to not work ``` Alendronate Calcium carbonate Ezetimibe Hydrocholorthiazide Simvastatin ```
Calcium carbonate
81
Dont take ciprofloxacin with
antiacids
82
2 month old Fever, vomiting, diarrhea Viral particles with a wheel- like shape
Rotavirus Segmented dsRNA viru (reovirus) No envelop Icoshedral
83
Primary pericarditis most commonly caused by
virus
84
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?
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%
85
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
Babesia Fever and hemolytic anemia Northeastern U.S Increase risk with asplenia Ixodes tick Ring form Maltese Cross Tx: Atovaquone + azithromycin
86
Antibiotic tx for meningitis --> develop hypotension and bilateral flank pain
Waterhouse- Friedrichsen syndrome Acute primary adrenal insufficiency due to adrenal hemorrhage Test with ACTH stimulation test
87
Condition in which slow recovery from paralysis
Pseudocholinesterase deficiency Slow at breakdown choline easters Sensitive to anesthetic drugs like succinylcholinen and mivacurium
88
5 cm blind outpouching on terminal ileum. Pathology will show
Hetertopic gastric mucosa Meckel diverticulum - Partial closure of vitelline duct - May have heterotropic gastric and/or pancreatic tissue
89
Splenectomy Target erythrocytes due loss of what part of spleen
Red pulp Primarily a filter designed to screen and eliminate defective or foreign cells White pulp= T cells
90
Location of most active cell division in epithelial repair A) Base of crypt B) Brunner glands C) Peyer patches D) Top of Villi
A) Base of crypt
91
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 ```
Aortic regurgitation Hyperdynamic pulse
92
Vancomycin-resistant Enterococcus mechanism
VRE strain of enterococcus that has acquired resistance to vancomycin through the uptake of a PLASMID that has the resistance
93
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) Basement membrane
94
Cor pulmonale
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
95
Scleroderma risk of developing
Pulmonary htn
96
Epilepsy driving rule
1 year w/o seizure
97
Blood dots on tongue and lips Progressive SOB Nosebleeds CLubbing nails Disease? What is causing SOB
Hereditary hemorrhagic telangiectasia (osler-weber-rondu) ``` Arteriovenous malformations (AVMS) - atrial septal defect ```
98
Tx for IBD | - MOA
Tx Diarrhea Loperamide Agonist at u-opiod receptors SLows gut motility Poor CNS penetration
99
Multiple sclerosis pathogenesis of the disease
CD4 T lymphocytes activated by myelin basic protein
100
High BP Hypokalemia Metabolic alkalosis Increased Renin and aldosterone Administer captopril - results in increase in renin
Renal artery stenosis
101
Renal osteodystrophy
Renal disease --> secondary hyperparathyroidism --> bone lesions Hypocalcemia Hyperphosphatemia Thinning of bones
102
2 weeks back pain | Two lesions in spine
Metastatic carcinoma of the breast
103
Missing superior parathyroid gland
Abnormal migration of endoderm for the fourth pharyngeal pouch 3rd pouch: inferior parathyroid and thymus 4th pouch: superior parathyroid
104
Lung that is underventilated but well perfused. This condition will lead to an increase in
Physiologic shunt
105
Chloroquine tx for Malaria (plamodium vivax). Initial response good but recurretn parasitemia 2 months later. Why?
Chloroquine is ineffective on the exoerythroytic malarial tissue stages
106
Lower GI bleeding Nothing on upper endoscopy or colonoscopy Blood in stool Cause of GI symptoms
Angiodysplasia Tortuous dilation of vessels --> hematochezia Right sided colon Older adults Confirmed by angiography Associated with - Aortic stenosis - Von willebrand disease
107
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
Leukomoid rxn Acute pyelonephritis + nitrates
108
Leukomoid rxn
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.
109
2 y.o fever sore throat rash Widespread sandpaper like rash over extremities. Purulent exudate on tonsils. Streptococcus pyogenes (group A) infection. Which toxin?
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
110
Streptolysin O toxin
Protein degrades cell membrane Rheumatic fever Beta-hemolysis
111
Pancreatitis cant digest triglycerides due to deficiency of
Colipase
112
Alcohol wipe inactivates which viruses
Enveloped virion
113
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
Inflammatory infiltrates in the interstitium Acute pyelonephritis - WBC in urine
114
Liver covered in yellow stuff
Fibrin
115
Low hemoglobin
Anemia
116
Hematocrit
Volume of RBC compared to total volume
117
Phase I reactions | - result
Oxidation Reduction Hydrolysis Slightly more polar Slightly more water soluble
118
Phase II reactions | - result
Methylation Acetylation Sulfation Glucuronidation Very polar Inactive
119
Major manifestations Familial chylomicronemia assoc with Familial hypercholesterolemia assoc with Familial dysbetalipoproteinemia assoc with Familial hypertriglyceridemia
``` 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
120
Hypoglycemia in Type I DM can be induced by (3)
1. Overdose of insulin 2. Decreased carbohydrate intake (skipped meal) 3. Physical activity/ exercise
121
Medullary thyroid cancer on histology
Nest of polygonal cells with congo red positive deposits Polygonal or spindle shaped cells with extrameduallary amyloid deposits
122
Branching structures with interspersed calcified bodies
Papillary thyroid cancer | Psammoma bodies
123
Polygonal shaped cells with extramedullary amyloid deposits
Medullary thyroid cancer
124
Follicular hyperplasia with tall cells forming intrafollicular projections
Tall cell variant of papillary thyroid cancer
125
Pleomorphic giant cell nests with occasional multinucleated cells
Anaplastic thyroid cancer, aggressive Often irregular giant cellsa dn biphasic spindle cells
126
Sheets of uniform cells forming small follicles
Colloid containing microfollicles suggests benign follicular adenoma
127
Fabry disease most at risk for developing
Renal failure ``` Neuropathic pain Angiokeratomas Telangiectasias glomerular disease (proteinuria) Cerebrovascular disease (stroke) Cardiac disease (left ventricular hypertrophy) ```
128
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 ```
B. 17a- hydroxylase
129
Alpha cell tumor
Glucagonoma
130
Insulin increasing drugs
sulfonylureas
131
Spliceosomes remove introns at
GU at 5' splice site AG at 3' splice site
132
What helps the mRNA exit the cytosol
poly A tail
133
What assists in ribosomal attachment to mRNA and prevents degradation of mRNA by 5' exonucleases
5' Cap
134
Androgenetic alopecia | - inheritance
Polygenic
135
Alkaline phosphatase does what
Promotes normal bone mineralization by increasing local concentrations of inorganic phosphorus
136
``` Low grade fever Skin rash Started on face and spread down 8 y.o LAD behind ears ```
Measles | - Togavirus
137
Progressive back pain Intermittent fever Vertebral boen destruction with fluid collection
Mycobacterium tuberculosis spondylitis (potts disease)
138
What promotes acen
Androgens | Not estrogen
139
First like tx for Gout
NSAIDS | - cyclooxygenase inhibitor
140
Chronic application of corticosteriods causes what to skin
Dermal atrophy
141
Osteoporosis histology description
Trabecular thinning with fewer interconnections
142
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
Lichen Planus
143
Lichen Planus features
``` 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 ```
144
Bluish tumor under nail bed
Glomus tumor (glomangioma) or a subungual melanoma Glomangioma - Modified smooth muscle cells of a glomus body - fxn thermoregulation
145
Terbinafine
Inhibits synthesis of ergosterol of the fungal membrane by inhibiting enzyme squalene epoxidase
146
Patient 40 y.o with diabetes having incontinence issues
Overflow incontinence due to impair detrusor contractility or bladder outlet obstruction
147
Acute dystonic reaction - is what - due to
Spasmodic torticollis Antipsychotic medication D2 antagonism of nigrostriatal pathway
148
What do you have to restrict in patient with ornithine build up?
Proteins Defect in urea cycle
149
Gingival hyperplasia
Phenytoin
150
Sudden onset of pain over right cheek lasting several seconds. Triggered by shaving or chewing. Shock like pain Tx MOA
Trigeminal neuralgia Carbamazepine - Reduces ability of Na channels to recover from inactivation
151
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 ```
B. Bile solubility Optochin sensitive
152
Bacitracin sensitive
Streptococcus pyogenes
153
Complete hemolysis
Group A Strep (s. pyogenes) | Group B Strep ( S. agalactiae)
154
Growth in hypertonic saline
gamma- hemolytic No hemolysis Enterococci S. bovis
155
Optochin resistance
Viridans group streptococci Bile insoluble
156
Tx Lyme disease
Doxycycline
157
More chloride in RBC Enzyme responsible
Excess HCO3 transferred out of RBC in exchange for Cl Carbonic anhydrase
158
Thickening of pleural membranes around whole lung Disease Due to Histology
Mesothelioma - Asbestos exposure Spindle cell positive for cytokeratin
159
Central areas of whorled collagen fibers in lungs
SIlicosis - inhaled silica Nodules of whorled collagen fibers and dust-laden macrophages
160
Small cell lung cancer positive for
Chromogranin | - neuroendocrine marker
161
Thick fibrinous exudate and pus in histology of lung
Empyema | - assoc w/ pneumonia
162
Primary diffusion impairment due to
Pulmonary fibrosis Emphysema Impaired gas diffusion
163
Baby born to diabetic mother as risk for
Transient hypoglycemia Glucose can cross but not insulin from mother
164
Superior sulcus tumor
Pancoast tumor - SVC syndrome - Horner syndrome - Spinal cord compression - Brachial plexus Tumor in apex of lung
165
Schizoaffective disorder. On Haloperidol and sertaline Found diffusely rigid without clonus Elevated serum creatinine Antidote?
Neuoleptic malignant syndrome Elevated creatine kinase due to rhabdomyolysis Tx dantrolene
166
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 ```
F. Succinate dehydrogenase
167
Brain tumor in HIV patient
Primary CNS lymphoma - arise from B cells - assoc with EBV
168
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 ```
Increased Tubular hydrostatic pressure
169
Overdose of theophylline can cause
Seizures and tachyarrhythmias Cardiotoxicity Neurotoxicity
170
Pneumocystis pneumonia vs aspergillus
Pneumocystis pneumonia - diffuse bilateral interstitial infiltrates Aspergillus - dense infiltrate involving right upper lung lobe
171
Cytotoxic exotoxin organisms
Clostridium botulinum Clostridium tetani Corynebacterium diphtheriae Promote host cell death
172
Hyaluronidase used by
S. aureus Streptococcus pyogenes Clostridum perfringens DIgest extracellular ground substance and enhance ability to spread
173
``` 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 ```
Dengue fever | - mosquito
174
``` Dysphagia Dry mouth Blurred vision Mydriasis Poorly reactive pupils ``` Suggests
Clostridium botulinum toxin - neurotoxin Inhibit ACh release Canned foods
175
Dynamic left ventricular outflow obstruction
Hypertrophic cardiomyopathy Crescendo-decrescendo systolic murmur
176
Integrase function
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
177
Swelling of knee and pain Facial palsy 3 months ago Hiking trip to New Hampshire Knee swelling with no erythema Tx
Lyme disease Asymmetric arthritis, single knee joint Encephalopathy with decreased memroy, somnolence and mood changes Tx Doxycycline - Penicillin type Ab - Ceftriaxone
178
Nephrotic syndromes - proteinuria - albumin - feature Does not have Examples
Heavy proteinuria Low albumin Edema No hematuria or red blood cell casts Diabetic nephropathy Membranous nephropathy Minimal change disease
179
Nephritic syndrome - proteinuria - albumin - features
<3.5 proteinuria Hematuria Red blood cell casts Azotemia HTN PSGN Membranoproliferative Lupus nephritis IgA nephropathy
180
Nephritic syndrome associated iwth normal complement levels
IgA neprhopathy
181
Use to test pancreatic function
D-xylose | - monosaccharide
182
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 ```
C. Neutrophils Granulomatosis with polyangiitis (wegners) Nasal mucosal ulcerations and glomerulonephritis + c-ANCA ( cytoplasmic staining anti-neutrophil cytoplasmic antibodies)
183
Hamartoma of lung
Pulmonary chondroma Coin lesion Popcorn calcifications Excessive growth of a tissue type native to organ Would find cartilage tissue in biopsy sample
184
Lung lesion with alveolar growth pattern without invasion
``` Bronchioloalveolar carcinoma (variatn of adenocarcinoma) ```
185
Areas most susceptible to atherosclerosis
Branch points that encourage tubulent blood flow Lower abdominal aorta Coronary arteries
186
Excessive bleeding in patient with renal dysfunction due to
Accumulation of uremic toxins Impair platelet aggregation and adhesion Prolonged bleeding Normal platelet count Normal PT and PTT
187
Other side effect of ACE thats not cough and angioedema
Hyperkalemia | Increase creatinine
188
Sore throat and fever Mild tonsillar erythema and exudates Clumped gram positive bacteria with polar granules that stain deeply with analine dyes Pathogenesis?
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
Complete molecule karyotype
46, XX only paternal DNA
190
Jejunum removal requires what supplementation after
Decrease in gastric acidity as diminishes iron absorption Iron absorption duodenum and proximal jejunum
191
Ascorbic acid absorbed where Pyridoxine absorbed where Biotin absorbed where Panthothenic acid absorbed where
Vit C: distal small bowel Pyridoxine (B6) jejunum and ileum Biotin (B7) small and large intestine Panthothenic aicd (B5) small and large intestine
192
Patients with panic disorder often develop
Agoraphobia
193
Patients that undergo organ transplantation and are on immunosuppressive therapy at risk for what Presentation Biopsy shows First line therapy -MOA Can cause
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
Fever, HA, myalgia, maculopapular rash Camping in appalachian mounts Tx - MOA
Rocky mountain spotted fever Rickettsia rickettsii - tick bite Doxycycline - Inhibits protein synthesis by binding 30s subunit
195
Pruritis Fatigue Sister has Sjogren + Antimitochondria Ab Histology of liver similar to what condition
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
Diazepam dont use with
Long acting benzodiazepam Dont use with other CNS depressants Alcohols Barbiturates Neuroleptics 1st generation antihistamines (chlorpheniramine)
197
Right gaze - right eye: right - left eye: forward Neutral normal Left gaze - both look left Convergence: normal
Left internuclear ophthalmoplegia Damage to medial longitudinal fasciculus Lesion at left dorsal pons
198
Bacteriodes tx
Gram negative anaerobic rods (beta lactamase can break down penicillins) Pipercillin + tazobactams
199
Azithromycin use
Macrolide 50S Inhibit protein synthesis Chlamydia Mycoplasma Haemophilus influenza Moraxella catarrhalis
200
Ceftriaxone use against
H. influenzae Klebsiella Neisseria Serratia
201
Ciprofoxacin used against
Second generation quinolone Inhibit topoisomerase II Legionella Pseudomonas
202
Vancomycin use against
MRSA (s. aureus) | Clostridium difficile
203
``` 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. 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
+ p-ANCA Lungs Kidneys Nasophagyngeal
Microscopic polyangitis
205
Amaurosis fugax
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
V1, V2, V3 elevations what artery associated
Left anterior descending artery
207
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 ```
D. Parvovirus B19 Fifth's disease Erythema infectiosum Slapped cheek - respiratory droplets - bone marrow suppression
208
Hand foot and mouth disease
Coxsackievirus type A - nonenveloped - linear ssRNA virus - fecal oral or contact - summer to early fall
209
Herpesvirus type 6
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
Streptococcus pyogenes | - rash
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
Hyperacusis
Increased sensitivity to certain frequencies and volume ranges of sound Decreased tolerance to sounds Lesion of facial nerve
212
1) Spinothalamic tract conveys | 2) Lateral corticospinal tract
1) Pain Temp Crude touch 2) Primary motor 3)
213
Brain is from what embryonic layer
Ectoderm | - Neural tube
214
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
1) Osteosarcoma 2) Chordomas 3) Giant cell tumor 4) Chondrosarcoma
215
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 ```
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
Case control
Know outcome looking for risk factors Odds ratio
217
Odds ratio is for
Case control Not cohort studies
218
Measured in cohort studies
relative risk
219
Extrinsic eye muscles - Innervation - fxn
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
Diplopia when looks down what extraocular muscle
Superior oblique | - trochlear nerve
221
What channels blood to muscles during exercise
Metabolites - CO2, H, K, Adenosine - decreased O2 Dilates arteroles locally
222
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
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
Boerhaave syndrome
excruciating retrosternal chest pain due to intrathoracic esophageal perforation after vomiting
224
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 ```
B. Amitriptyline TCA - Cardiotoxicity - Convulsions - antiCholinergic
225
Barretts esophagus is what
Columnar metaplasia replacing normal squamous epithelium; esophageal adenocarcinoma
226
CTG trinucleotide in a serine-threonine kinase caused by
Myotonic dystrophy type I (DM1) Instability during maternal meiosis
227
Instability during both maternal and paternal meiosis
Friedreich ataxia - AR GAA repeat Limb and gait ataxia Cardiomyopathy DM
228
Instability during paternal meiosis
Huntington disease | CAG repeat
229
BRCA mutation affects what gene repair
Homologous recombination
230
Intrauterine adhesions what is seen in tissue biopsy
Absent stratum basalis in an endometrial biopsy
231
Uncontrollable facial and chest flushing Diarrhea Wheezing Elevated 5-HIAA Tx Can led to Additonal finding
Carcinoid syndrome - secretion of serotonin Octreotide Niacin deficiency Tricuspid regurgitation
232
Arterial blood gas volumes on COPD patient pH Oxygen tension Carbon dioxide tension Oxyhemoglobin saturation
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
Metformin Atorvastatin Lisinopril Drug taht prevents progression of kidney disease inhibits an enzyme found where
Lisinopril | - inhibits ACE which is found in the lung
234
Diabetic nephropathy on renal biopsy
Uniform glomerular basement membrane thickening
235
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?
Hepatitis A virus 2-6 weeks incubation ``` Not Ecoli Not salmonella (H2S positive) ```
236
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
Ebola causing DIC Quarantine and fresh frozen plasma
237
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
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
Heart issue seen in alcoholics
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
Disorganized hypertrophic myocardial fibers with
hypertrophic cardiomyopathy (HCM). LV hypertrophy Obstruction of LV outflow Diastolic dysfunction
240
1) Microcytic hypochromic RBC with coarse basophilic stippling 2) Microcytic hypochromic RBC with elongation
1) Beta-thalassemia | 2) Iron deficiency anemia
241
Basophilic stippling
Lead poisoning
242
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.
Whipple disease Diarrhea Steatorrhea Malabsorption Joint pain PAS stain Gram positive bacillus
243
IBS characteristics
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
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 ```
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
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 ```
D. Serotonin syndrome Cognitive impairments Autonomic instability Somatic effects Hyperreflexia **
246
Hypertensive crisis
``` 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
Malignant hyperthermia
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
Neuroleptic malignant syndrome
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
TCA overdose
Dry mouth Constipation Urinary retention Fatal arrhythmia Tachycardia
250
Hand foot and mouth - virus - description of virus
Coxsackie A virus Naked icosahedral capsid, single stranded RNA Positive sense (+)
251
Food stuck in throat Iron deficiency anemia At risk for what cancer
Plummer vision syndrome Esophageal webs Iron deficiency anemia Dysphagia Esophageal squamous cell carcinoma
252
Sleep walking
CNS immaturity Normal TCA (imiprmine), benzo, SSRI if continued or injury high risk
253
What would increase MVP murmur
Valsalva maneuver Decrease volume of left ventricle, causes the prolapse to occur sooner
254
Increase preload maneuver
Squatting Isometric handgrip Aortic regurg louder
255
Inspiration on heart murmur
increase right heart sounds
256
Hand grip
Increase afterload Increase intensity MR, AR, VSD Decrease hypertrophic cardiomyopathy and AS murmurs
257
Valsalva
Decrease preload Decrease intensity of most murmurs Increase hypertrophic cardiomyopathy MVP earlier onset
258
Rapid squatting
Increase venous return Increase preload Incerase afterload Decrease intensity of hypertrophy cardiomyopathy Increase MR, AR, and VSD murmur MVP later onset
259
Cirrhosis on liver - Alcohol - Autoimmune
causes nodules in the lobules Alcohol - uniform small nodules (micronodular) hepatic fibrosis Autoimmune - lymphocytes, large nodules hepatic fibrosis
260
Triangular space Quadrangular space Triangular interval
1) Triangular space - Circumflex scapular artery 2) Quadrangular space - Axillary n. - Posterior circumflex humeral artery. 3) Triangular interval - deep brachial artery - radial nerve
261
VHL syndrome
AD Multiple tumors including hemangioblastomas, RCC, pheochromocytomas
262
Uses 1) Amphotericin B 2) Ivermectin/ thiabendazole 3) Metronidazole
1) Severe systemic fungal infections 2) nematode infection, strongyloides stercoralis 3) Anti-protozoan drug, and anaerobic bacteria (not fungal infections)
263
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?
MS Periventricular plaques on MRI
264
Enlarged bilateral cystic ovaries in obese infertile female due to lab values associated with
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
Infectious colitis
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
Associated with obstructive sleep apnea ``` A. Cataplexy B. Cheyne-Stokes respirations C. Hallucination while falling asleep D. Increased sleep latency E. Pulmonary hypertension ```
E. Pulmonary hypertension
267
Cheyne-Stokes respiration
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
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 rise in acetylcholine REM sleep
269
Slowest and highest amplitude waves on EEG
Delta brain waves non-REM stage 3
270
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
C. Right ventricular outflow obstruction with aortic dextroposition and interventricular septal malformation Tetralogy of Fallot
271
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
B. Isolated malformation of the interventricular septum VSD
272
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
E. Thickened aortic wall media Turner syndrome Coarctation of aorta
273
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
D. Shunt between aorta and pulmonary artery PDA Machine like murmur
274
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
E. Non-gram staining bacteria Chlamydia trachomatis - lacks cell wall - gram negative like NAATs**
275
Thayer-Martin
Gonorrhea
276
Tx Chlamydia
Doxycycline | Azithromycin
277
Used to tx? STI 1) 5-flurouracil 2) Acyclovir 3) Metronidazole 4) Penicillin
1) HPV 2) HSV 3) Gardnerella vaginalis 4) Syphilis (trepponema pallidum)
278
Organism that requires similar environmental conditions for growth and production as chlamydia trachomatis
Rickettsia prowazekii Obligate intracellular bacteria
279
Type of organism environment 1) E.coli 2) Listeria monocytogenes 3) Pasteurella multocida 4) Staphylococcus species
1) Facultative anaerobe 2) Facultative intracellular anaerobe 3) Facultative anaerobe 4) Facultative anaerobes
280
cecum location
right lower corner right before ascending colon
281
Topiramate on other medication
CYP3A4 inducer Increases metabolism of hormones
282
Measles type of virus
Paramyxoviridae virus
283
Picronaviridae
Coxsackievirus
284
Togaviridae virus
Rubella
285
ss linear RNA virus with icosahedral capsid ``` A. Bunyavirus B. Orthomyxovirus C. Picornavirus D. Polyomyavirus E. Reovirus ```
C. Picornavirus
286
Description 1) Bunyavirus 2) Orthomyxovirus 3) Picornavirus 4) Polyomyavirus 5) Reovirus
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
``` Turkish Mediterranean descent Mouth and genital ulcers No sexual history Uveitis Erythema nodosum ``` What is it Associated with
Behcet syndrome Immune complex vasculitis Associated iwth HLA-B51
288
Nucleoside reverse transcriptase inhibitor (NRTI) ``` A. Acyclovir B. Efavirenz C. Nelfinavir D. Saquinavir E. Zidovudine ```
E. Zidovudine Acyclovir - Guanosine analog - HSV tx Efavirenz - non-nucleoside reverse transcriptase inhibitor Nelfinavir and saquinavir: protease inhibitors
289
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. Decreased plasma colloid oncotic pressure Cirrhosis of liver Decreased production of albumin
290
Meissner Ruffini Merkel Pacinian
Meissner - superficial - fine/ light touch Ruffini - superficial - pressure, finger tips Merkel - Deep - Pressure, deep static touch Pacinian - Deep - Vibration and pressure
291
16 y.o with mild scleral icterus without jaundice. Elevated direct and total bilirubin. Elevated urinary coproporphyrin I. Due to
Rotor syndrome Altered ability to transport bilirubin glucuronides into bile canaliculi
292
Esophageal varices due to what vessels
Left gastric | Azygos
293
Periumbilical varices due to what vessels
Superficial epigastric | Branches of paraumbilical veins
294
Rectal varices due to what vessels
Superior rectal vein with the middle and inferior rectal veins
295
``` 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
Vitamin B6 deficiency Sideroblastic anemia Numbness of extremities Glossitis Cheilosis
296
Bullet that is necrosis
Gas gangrene Clostridium perfringens Gram positive spore forming obligate anaerobic bacillus. Produce alpha toxin - a phospholipase that degrades tissue and cell membranes
297
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
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
Paget disease of breast biopsy
Large, atypical cell with clear halos within the epidermis
299
Nodular proliferation of cells extending from the stratum basalis
Basal cell carcinoma
300
Stromal overgrowth with compressed glandular structures
Phyllodes tumor - fibroepithelial stroma of teh breast Multinodular firm and painless masses
301
Latent infection Capitans wheel Fungal Central america
Paracoccidioidomycosis brasiliensis
302
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
1) Giardia lamblia 2) Norovirus 3) Campylobacter jejuni 4) Vibrio cholerae 5) E. Coli
303
Lab findings with CLL Associated anemia
Elevated LDH Elevated beta-2 microglobulin Autoimmune hemolytic anemia - Spherocytes
304
Lung maturity when
36 weeks
305
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 ```
D. Giardia lamblia Motile trophozoites or oval cysts
306
Cryptococcus neoforms
encapsulated yeast Meningococcal manifestation in AIDs patients
307
Cryptosporidium parvum
chronic watery diarrhea in IC patients AIDs associated diarrhea Positive for acid fast stain
308
Tx Giardia lamblia
Metronidazole Assoc disulfram like rxn
309
Metronidazole
GET GAP on the Metro ``` Giardia Entameoba Trichomonas Gardnerella Anaerobes (clostridium, bacteroids, actinomyces) h. Pylori ```
310
``` 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
E. Gram positive spore forming rod Clostridium tetani
311
Clostridium tetani exotoxin MOA
Decreased release of inhibitory neurotransmitters GABA adn glycine
312
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 ```
E. Spinothalamic tract
313
Patient with MS and spasticity tx
Baclofen (Agonist at the GABA-B receptor) Tizanidine (alpha 2 agonist)
314
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 ```
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
Insulin uses which molecules for effect ``` A. Janus kinase (JAK) B. Lipoxygenase C. Phospholipase C D. Protein kinase A E. Protein phosphatase ```
E. Protein phosphatase Receptor tyrosine kinase - MAP kinase - PI3K --> protein phosphatase
316
JAK second messenger for
Growth hormone Prolactin IFN IL-..
317
Patient begins nasal cannular oxygen supplementation. Respiratory rate decreases shortly after beginning. Caused by?
Carotid bodies Supplemental oxygen administered rapid increase in PaO2 --> reduced peripheral chemoreceptor stimulation and decrease respiratory rate
318
Carotid bodies vs central chemoreceptors
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
Parenternal nutrition and gall stones
Decreased cholecystokinin release due to lack of enteral stimulation
320
Reverse methotrexate toxicity
Folinic acid | Leucovorin
321
HIV associated nephropathy (3)
Hematuria Hypertension Edema
322
``` HIV started treatment Edema Fatigue Elevated creatinine Decreased phosphorus Proteinuria Glucosuria Loss of brush border and basement membrane denudation Intracytoplasmic eosinophilic inclusions ```
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
Sudden cardiac death in 20 y.o Mutation in protein belong to which structure
Sarcomere - beta myosin heavy chain - Myosin-binding protein C
324
Results from mutations affecting proteins that make up desmosomes (plakoglobin, desmoplakin)
Arrhythmogenic right ventricular cardiomyopathy
325
Metformin tx measure what ahead of time
creatinine level renal insufficiency
326
Male | Sclerotic bony metastases in lumbar spine
Prostate cancer Osteolytic (lucent) - osteoclast stimulation Osteoblastic (sclerotic) - osteoblast activity
327
Angiogenesis is driven by
Blood vessel formation Vascular endothelial growth factor (VEGF) Fibroblast growth factor
328
Epidermal growth factor (EGF) does waht
mitogenic influence of epithelial cells, hepatocytes and fibroblasts
329
Artery associated with elevation in leads II, III, avf
Right coronary artery
330
Tumor penetration of basement membrane uses which substances
Collagenases and hydrolases (Metalloproteinase)
331
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?
Vitamin A Cystic fibrosis - deficiency of fat soluble vitamins (ADEK)
332
Myelofibrosis - type of malignancy - clonal expansion of - secretion of
Hematopoietic stem cell malignancy Megakaryocytes TGF-beta secretion - stimualtes fibroblasts to fill medullary space with collagen.
333
Risk factors for diverticular disease
Diet high in red meat, fat and low in fiber
334
Hip fracture. Damage to which artery causes osteonecrosis
Medial circumflex
335
Metabolism of calories per gram 1) Protein and carbs 2) Fat
1) Protein and carbs - 4 calories/ gram 2) Fat - 9 calories/ gram
336
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
Granulosa cell tumor - secreting estrogen Call-Exner bodies
337
Duchenne muscular dystrophy mRNA change
Nonsense mutation UCA --> [ UAA, UAG, UGA]
338
Monoclonal Ab for CD20
Rituximab
339
Infliximab - type - use
TNF-alpha monoclonal Ab Rheumatoid arthritis ankylosing spondylitis Crohns
340
Interleukin-2 - MOA - use
Regulates activation and differentiation of T-cells to aid in tumor cell destruction RCC Melanoma
341
Imatinib - MOA - Use
BCR/ ABL CML
342
Abciximab - MOA - Use
Monoclonal Ab againts platelet GP IIb/IIIa receptor Block platelet aggregation Acute coronary syndrome
343
Gardnerella vaginalis vis Giardia lambila
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
Alcohol associated level of hepatic injury Poor prognosis
``` Alcohol steatosis (reversible) Alcoholic hepatitis (reversible) Alcohol cirrhosis (irreversible) ``` Prolonged PT time
345
Gamma glutamyl transferase level
High level more specific for biliary injury
346
Decrease risk of bone fractures and breast cancer
Raloxifene
347
Rifaximin - mOA - given in addition to
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
Celiac disease - Calcium - Phosphorus - PTH
Vitamin D deficiency Deficiency calcium Increase PTH Decrease phosphorus
349
60 y.o with lactose intolerance for 2 months - due to - decrease what
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
Neurologic regression Hepatosplenomegaly Diminished reflexes Cherry red spot
Niemann Pick | - Spingomyelin
351
Lung tissue microscopic examination: spherules packed with endospores
Coccidioides immitus - dimorphic fungus - central california, arizona, new mexico
352
Pyelonephritis --> hypoxic and breathing issues Due to? Phases
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
Pica
compulsie consumption of nonstaple food or non-nutritive substance for >= 1 month
354
Total gastrectomy need to supplement
A water soluble vitamin B12
355
Midline posterior fossa mass | Sheets of primitive cells and mitotic figures
Medulloblastoma
356
Impaired neuromuscular transmission
Myasthenia gravis | - autoantibodies to ACh receptors
357
Lysing of blood cells when incubated in hypotonic saline with glycerol
Hereditary spherocytosis (HS)
358
Rheumatoid arthritis affects what part of spine
Cervical
359
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 ```
D. Recurrent miscarriages SLE - antiphospholipid antibodies Hypercoagulable state
360
Influenza vaccine MOA
Inhibition of viral entry into cells Inactivated versions - neutralizing antibodies to hemagluttinin ag
361
HIV patient CD4 400 Fever chills productive cough Organism?
Strep. pneumoniae
362
Increases urea reabsorption in collecting tubules
Vasopressin (ADH)
363
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
Hypertrophic cardiomyopathy Involves hypertrophy of interventricular septum and obstruct LV outflow Mass: increased Cavity size: small Ejection fraction: preserved Relaxation: impaired
364
Patients with MG are extremely sensitive to what drug
Vecuronium Rocuronium Nondepolarizing agaents
365
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?
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
Erratic behavior HIV CD4 of 30/ mm3 Demyelination
JC virus - no edema - latent infection - attack olgiodendrocytes Produce progressive multifocal leukoencephalopathy
367
Gout can be caused by
Increased urate production - myeloproliferative/ lymphoproliferative disorders (polycythemia vera) - tumor lysis syndrome - HGPPT deficiency Decreased urate clearance - chronic kidney disease - thiazide/ loop diuretics
368
Type 2 DM Confusion lethargy Hypoglycemia Elevated C-protein What drug was used
Medication that stimulates pancreatic insulin secretion independent of blood glucose levels Sulfonylureas (glyburide)
369
Epinephrine administered after pretreatment with Drug A cause increase in insulin. Drug A blocks?
Alpha 2 adrenergic receptors
370
Epinephrine with what receptors increase insulin secretion
Muscarinic M3 (Gq) Glucagon (Gs/Gq) Beta 2 adrenergic (Gs) GLP-1 (Gs)
371
Painless Testicular tumor Elevated lactate dehydrogenase Elevated alpha fetoprotein
Nonseminomatous germ cell tumor - embryonal carcinoma - yolk sac tumor - choriocarcinoma hCG AFP
372
Li-Fraumeni syndrome
TP53 ``` Sarcomas Breast cancer Brain tumors Adrenocortical carcinoma Leukemia ``` AD
373
5 y.o sunburns easily. Skin becomes red and scaly with minimal sun exposure. Hyperpigmented skin. Few nevi on hands. Defect of?
Xeroderma pigmentosum - AR - defective nucleotide excision repair of DNA dmaged by UV light
374
Flutamide MOA
Impaired androgen receptor interaction Competitive testosterone receptor inhibitor
375
Leuprolide MOA
Long acting GnRH agonist | - decrease testicular leydig cell stimualtion
376
Anastrozole MOA
Aromatase inhibitors Decrease peripheral convertsion of androgens to estrogen
377
Finasteride MOA
Decreases peripheral convertsion of testosterone to DHT by binding 5alpha reductase
378
Shigella infects via what cell
microfold (M) cells at base of mucosal villi within a Peyers patch
379
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
B. Fibrous replacement of the muscularis in the lower esophagus CREST syndrome
380
latent infection in neuronal cell bodies
Ganglia HSV
381
Kidney stone given morphine sulfate for pain. Fifteen minutes later, develops diffuse itchy rash MOA?
IgE INDependent mast cell degranulation
382
Pompe disease deficiency of
acid alpha-glucosidase
383
Concentrations of K along nephron Bowman capsule PCT Ascending Loop of Henle Collecting duct
Bowman capsule 100% PCT 35% LOH 10% Collecting duct 110%
384
Prion disease causes what in brain
sponge-like vacuolated neurons in gray matter
385
Intranuclear inclusions in oligodendrocytes
Progressive multifocal leukocencephalopathy due to JC virus
386
PTSD tx
SSRI
387
Prevention for Group B strep infection
Intrapartum ampicillin
388
Gas gangrene
Clostridium perfringens Also causes transient watery diarrhea and abdominal discomfort
389
Bone pain Hearing impairment Multinucleated cells with over 100 nuclei -Factor essential for differentiation of cells
Paget's disease of bone | RANK-L Receptor activator of nuclear factor kappa-B ligand
390
Mitral regurgitation - Afterload - Preload - Ejection fraction
Afterload: decrease (regurg so low resistance) Preload: increase (LV end-diastolic volume) EF: Increase (decreased afterload --> increase EF)
391
Polyp formation steps
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
Pretreatment for MPTP toxicity produced by MAO type B
Selegiline
393
5 y.o, bites on inbetween toes. Stool shows smooth thin walled eggs. Infection? Complication
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
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. Chloramphenicol Aplastic anemia - Carbamazepine - Chloramphenicol - Sulfonamides
395
42 y.o episodic SOB adn cough. FEV1 is 71%. Predominant eosinophils Causea
Asthma - Animal dander - Dust mites and cockroaches - Pollens and molds
396
Nondepolarizing block vs depolarizing block
Nondepolarizing block - vecuronium - Gradual decrease Depolarizing block - Succinylcholine - phase I: constant but diminished phase 2: gradual decrease
397
Outcome Hep B virus
``` Complete resolution (>95%) Chronic hepatitis (with or without cirrhosis) Fulminant hepatitis with massive liver necrosis ```
398
Brain natriuretic effect on kidney
Increases sodium excretion Increase GFR
399
Anterior nucleus of hypothalamus Fxn Lesion
Panting or sweating Lesion= hyperthermia
400
Dorsomedial nucleus of hypothalamus Fxn Lesion
Rage Lesion= decreased aggression and feeding
401
Lateral nucleus of hypothalamus Fxn Lesion
Increased feeding Lesion= decreased feeding
402
Supraoptic nucleus of hypothalamus Fxn Lesion
Increased blood volume, blood pressure and metabolism Lesion= diabetes insipidus
403
Ventromedial nucleus of hypothalamus Fxn Lesion
Decreased feeding Lesion= increased feeding
404
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
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
Otitis media organism
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
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. 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
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
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
First line A-fib
Dofetilide Class III antiarrhythmic Blocks K channels
409
First line tx SVT
Adenosine
410
Sarcoidosis causes elevated level of CXR
ACE ACE is produced by the granulomas in sarcoidosis Enlarged hilar lymph nodes and bilateral pulmonary reticular opacities
411
Ramelteon MOA
Positive actions on the suprachiasmatic nucleus Selective melatonin receptor AGONIST - binds MT1 and MT2 in suprachiasmatic nucleus
412
29 y.o recurrent epistaxis. Frequent nose bleeds now anemic. Father same symptoms with GI bleeding. Decreased hemoglobin Positive hemoccult
Osler- Weber Rendu - hereditary hemorrhagic telangiectasia - AD Dilated blood vessels
413
Achalasia | - loss of
Loss of myenteric plexus Loss of nitric oxide synthease producing neurons
414
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 ```
D. Onchocerciasis Onchocerca volvulus - parasite - black fly Parasitic larvae into blood stream with bite Ivermectin
415
Oral ulcers Genital ulcers Eye redness and pain
Behcet syndrome Turkish descent Immune complex vasculitis
416
Spiking fevers hepatosplenomegaly Pancrytopenia - Disease - organism - transmitted - tx
Kala-azar aka visceral leishmaniasis Caused by parasite Leishmania donovani Sand fly India Sodium stibogluconate
417
Worms seen in eyes (conjunctiva) Swelling of skin - Disease - organism - transmitted - tx
Loiasis Parasite Loa Loa Chrysops flies (Deer fly, horse fly, mango fly) Tx: Diethylcarbamazine
418
Tsetse fly
Trypanosoma brucei gambiense adn T.b. rhodesiense African sleeping sickness
419
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
Laryngotracheobronchitis - aka croup Bark like cough Subglottic narrowing "Steeple sign" Parainfluenza virus type 1 - Paramyxoviridae - enveloped helical nucleocapsid negative sense ssRNA virus
420
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
B. A remnant of Rathke's pouch Craniopharyngioma Ectoderm Supra cellar calcifications
421
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
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
Infraorbital nerve - division of - does what
Terminal branch of maxillary division (V2) of trigeminal CN V Sensory information from the lower eyelid, side of the nose and upper lip
423
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 ```
Lynch syndrome - Hereditary nonpolyposis colorectal cancer C. Mismatch repair
424
Purine salvage defects
Lesch-Nyhan syndrome - deficency of HGPRT - self mutilation - hyperuricemia - mental retardation
425
Side effect of diphenhydramine
Dry mouth
426
``` 21 month old Sick all the time Oral thrush RSV and influenza Impetigo and exudative tonsillitis ```
Severe combined immunodefiviency
427
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. Anterior horn UMN - dysarthria - spasticity of elbow flexion - clonus of ankle reflexes LMN - Fasciculation of tongue - Fasciculations in biceps muscles
428
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
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
``` 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
Lateral medullary syndrome RIght PICA
430
Loss of pain and temp on face and body Ipsl facial hemiparesis Ipsilateral deafness C/L body analgesia
Lateral pontine syndrome AICA
431
Contralateral hemianesthesia C/L homonymous hemianopia Ips horizontal gaze preference
MCA
432
``` Fever that rises and falls through day Night sweats Joint pain Heart murmur Mexico Goat cheese and unpasteurized milk ```
Brucellosis
433
Recurrent pyogenic infections Oculocutaneous albinism Progressive neurologic abnormalities Coagulation defects
Chediak-Higashi syndrome - AR Abnormal lysosomal trafficking protein that results in defective phagolysosome formation
434
Skin infection on leg. Red shiny and tender. Fever. Gram positive cocci, catalase negative, sensitive to bacitracin Virulence factor?
Cellulitis Streptococcus pyogenes M protein
435
Iron poisoning tx
Deferoxamine
436
Lead poisoning tx
Dimercaprol EDTA Succimer
437
Flumazenil
Antidote for benzodiazepine overdose
438
Deferoxamine
Tx iron poisoning
439
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 ```
Hypoglycemia Second generation sulfonylureas - glyburide - glimepiride - glipizide
440
Nephritic vs Nephrotic types
``` 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
``` 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
Membranoproliferative glomerulonephritis Hematuria and proteinuria Edema
442
``` Edema Foamy urination Proteinuria Low hematuria Biopsy: diffuse thickening of walls of the glomerular capillaries ```
Membranous glomerulonephritis
443
Temporal vs parietal radiation visual defect
Temporal -upper right quadrant Parietal - Lower left quadrant
444
``` Fever Rash Dysuria Urinary urgency Hematuria, mild proteinuria WBC (eosinophils) in urine Azotemia Costovertebral angle tenderness ``` Diagnosis Caused by
Acute interstitial nephritis Drug induced ``` 5 P's Pee (diuretics) Pain-free (NSAIDs) Penicillins and cephalosporins Proton pump inhibitors RifamPin ```
445
Polyribosylribitol phosphate (PRP)
Makes polysaccaride capsule
446
Eosinophilic cell
Bright pink cell
447
Hep B vs Hep C Nephrotic disease
Hep B Membranous GN > Membranoproliferative GN Hep C Membranoproliferative GN > Membranous GN

AM- STEP1 (20 decks)

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